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PROJECT NAME <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />Avenue <br />PROJECT NO 116-139 FINAL COST $25.310.30 <br />CONTRACT SIGNED 12/22/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Lining a 15" VCP sewer that is 495' long & 19' deep in the 1100 block of Notre Dame Ave. <br />WITNESSETH: <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 Bend which were a part of the above Contract. <br />Execu this lay of February 201 7 Insituform Technologies USA, LLC <br />' / aAt.�? Company Name <br />Signat4b 17988 Edison Avenue <br />Jana Lause, Contracting & Attesting Officer Company Address <br />Printed Name Chesterfield, MO 63005 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared �Lu =N <br />Jana Lause and acknowledged his/her signature to the above Project Completion Affidavit on <br />a ,v_i op !3c <br />the 1 day ebuary 201 7 E � o <br />Notary Signature My Commission Expires SGc yt. 2020 <br />Diane Partridge �� 0 <br />Printed Name County of Residence St. Louis ;, a! S; <br />:Q: U J:VA <br />If the Contractor is a corporation, the following certificate will be executed. t.:?, <br />I, Whittney Schulte certify that I am 4ecre{ary of the Corporation executing this release; the t'...: •`'' <br />Jana Lause who signed this release on behalf of the contractor was then <br />Contracting & Attesting Officer 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 Sig lure <br />Corporate Seal <br />Whittney Schu tc, Assistant Secretary <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This�s acceepta,brla Dr f al approval and we recommend to the Board of Public Works that it be ordained so. <br />V Date: 2 • C. • l'l <br />ConstructioeA <br />Ynager <br />AnkAM-- <br />Gary A. Gil resident <br />BOARD OF PUBLIC WORKS APPROVAL Date: / )-o f <br />Suzanne M. Fritzberg, Member <br />Therese J. Dorad, Mdmber JaVs A. Mueller, Member <br />Elizabeth A Maradik, Member <br />Qda M. Martin, CI kk <br />