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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS ati, <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. <br />Executed this � day of QcN em ke r , 201_ Caretaker Landscape & Lawn <br />K-k6oba., PA jr�ozd Company Name <br />iSignature P.O. Box 324 <br />K in��ee 11e 1 d Company Address <br />'Printed -�Name Michigan City IN 46360 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said <br />KcA L.wv` N'4�4r�l, and acknowledged his/her_ sionat <br />the o�31L- day of NO t-) e *,6 -,, 201 (P <br />�Iv1i /t <br />Printed Name <br />and state, personally appeared <br />e above Project Completion Affidavit on <br />HOLLY M. KOLASA <br />La Pate County <br />My Commission Expires <br />z <br />I&miccion LIMA 2024 L <br />County of Residence L r- Po r, q -e <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, 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 />Date: 11 • t L • L <br />ruc Consttio Hager <br />BOARD F PUBLIC WOf; CS APPROVAL Date: PO%C, <br />Vary A. Gilot' President Sluzanna M. Pritzberg,'embe Elizabeth A. aradik, Member <br />i <br />Therese J. Dora , Member JamO A. Mueller, Member inda M. Martin, Jerk <br />