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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />Al <br />eery, <br />CITY OF SOUTH BEND, INDIANA %'� <br />BOARD OF PUBLIC WORKS - <br />PROJECT COMPLETION AFFIDAVIT <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under c <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cit, <br />of South Bend which were a part of the above Contract. pp <br />Executed this ft�t CKttCT day of ( 2Q Caretaker Landscape & Lawn <br />—VOAA�tOQ,Y1 1\l f fir\ CM1 Company Name <br />'S,i/g�njattprret I P.O. Box 324 <br />) W)Y` \pSpe-r\ �s_1iy� J Company Address <br />Printed Name Michigan City, IN, 46360 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and f <br />ii�+4 1 Qr 1 • ram, and acknowledged his/her <br />the or Q- day of 9C. U,e 201 <br />r said country and state, personally appeared <br />signature to the above Project Completion Affidavit on <br />HOLLY M. KOLASA <br />La Pate Canty <br />My Commission Expi <br />n Qgkq�6, 20 ) Cp- <br />Printed Ndme County of Residence L.o Po r4 i <br />If the Contractor is a corporation, the following certificate will be executed. <br />certify that I am Secretary of the Corporation executing this release; that <br />who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />CX C Date: <br />Construction; 9nager <br />aaryA. Gilo, President <br />Therese J. Dor u, Member <br />BOARD F PUBLIC WORKS APPROVAL Date: A" -3 A <br />uza na . F ' berg, Me er Elizabeth A. Maradik, Member <br />Jam s A. Mueller, Member 1 da M. Martin, Cl k <br />