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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 <br />PROJECT COMPLETION AFFIDAVIT <br />Demolition of 11 Houses <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 ( <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 />Execu � o 201 19 Indiana Earth, Inc. �32 <br />Company Name <br />Si nature 10343 McKinley Hwy <br />t6*m �SLGIi_. ��:rr 10Ef�11' Company Address <br />Printed Name Osnenla In 4eSs1 <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appea <br />Ph!4i aI- G. , and acknowledged his/her signature to the above Project Completion <br />the Y day of 201 CD <br />lotary Signa ure My Commission Expires <br />air I ice. ?)�kc S�2i <br />Printed Name County of Residence <br />`sellSSIOpF IN <br />on ' N: <br />SEAL <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, M4{C K c'�,SL.ee7 , certify that I am Secretary of the Corporation executing this release; that <br />M,4k.K,o�- L4" 7Z who signed this release on behalf of the contractor was then <br />/PcW l— of said Corporation; that said release was duly signed for and on behalf of said <br />Corpo ®thori it 6v rningg bo�ithin the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />06A A-Q L- e,s I.r'-� 5>57L, <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable ������ppppppr net approval and we recommend to the Board of Public Works that it be ordained so. <br />�— Date: l 1 • I & • t (. <br />Constructio -M Hager <br />BOA D OF PUBLIC WORKS APPROVAL Date: I / `i/� l 7 <br />4 �/Z ,/ uk <br />Gary A. Gilot, President s Z, -, G <br />or, Faa+coscq , .ce ee c Ebeth A Maradik, Member <br />Therese J. Dorau, ember Jan s A. Mueller, Member in a M. Martin, Clerk <br />