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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />W ITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS' <br />1= <br />PROJECT COMPLETION AFFIDAVIT ,a� <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 or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South which we a part of the above Contract, <br />day of Dacemhpr 2016 <br />Name <br />WITNESSESS: <br />Before me, the undersigned Notary Public in <br />Dustin Hilary , and acknowledged <br />theT1 th day of December , 201 b <br />Printed Name <br />County of Residence <br />Walsh Kelly Inc. <br />Company Name <br />24358 State Road 23 <br />Company Address <br />South Bend, IN 46614 <br />City, State, Zip <br />sally appeared <br />Completion Affidavit on <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, —1 Mi chaps Leh&HID certify that I am Secretary of the Corporation executing this release; that <br />—Diistin u; 1 a y who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on`�JIb4}b�ly� <br />�Gorpg i ^ by Authgyty oOs governing body, and is within the scope of corporate powers: ��� KEQ(, ij <br />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 or <br />1 Date: <br />Constructi nager <br />.BOARD OF PUBLIC WORKS APPROVAL Date: / to <br />Gary A. . itz President <br />Suzanna erg, M ber Elizabeth A. Mara( <br />Therese J. Dorau, Member James A. Mueller, Member Ljhda M. Martin, C <br />RPORATF <br />�-rguate Scal <br />.SEAT-" <br />Member <br />