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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />;o�uxxa e <br />CITY OF SOUTH BEND, INDIANA = <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />Ireland Road Emergency Repairs <br />116-083E FINAL COST $59,500.55 <br />Emergency storm damage repair of the <br />PROJECT DESCRIPTION Ironwood Rd <br />WITNESSETH: <br />ditches along Ireland Rd, east c <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 ab ve Contract. <br />Exec d th' 0t ay ❑ ber 201 6 HRP Construction Co. <br />Company Name <br />Signature 5777 Cleveland Rd <br />Matthew D. Cain, President Company Address <br />Printed Name <br />South Bend, IN, 46628 <br />City, State, Zip <br />W ITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Matthew D. Cain , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 30th dayof November 2016 <br />Notary Signature _ My Commission Expires 3/06/24 <br />Cindy Vanheste <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />Nancy Knapik certify that I am Secretary of the Corporation executing this release; that <br />Matthew D. Cain who signed this release on behalf of the contractor was then <br />President 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 />Nancy Knapik <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable for fin +approval and we recommend to the Board of Public Works that it be ordained so. <br />CI • Date: t ( - 8 t 4 <br />Constructio Hager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilot, President v� Suzann M. Fritzberg, Member Elizabe h A. Maradik, Member <br />Therese J. Dorgiu, Member Ja s A. Mueller, Member b M. Martin, Clerk <br />