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ON. <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKSPROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2016 Downspout Disconnect Program <br />PROJECT NO 115-098 FINAL COST $9,060.20 <br />CONTRACT SIGNED 6/28/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Remove downspouts connected to the combined sewer from willing resident dwellings <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 at Bend wh' h were a art roof the above Contract. <br />201�. Acorn Landscaping LLC <br />Company Name <br />Si atu 3680 W. Sample St <br />lrf N o E ,, LINDAJ GILROY Company Address <br />Public, State of Indiana <br />Printed Name nr.n:•, St. Joseph County South Bend, IN, 46619 <br />. —^� '�' Commission N 629162 <br />. SEAS, toy commission Expires City, State, Zip <br />WITNESSETS: <br />'%.,;No August 31, 2019 <br />mrrt"` <br />Before me, the undersi ned Notary u is in and for said country and state, personally appeared <br />.r%��� ATIVCRANand acknowledged his/her signature to the above Project Completion Affidavit on <br />the day ofadX,11%Cy,201_�. <br />L/ : <br />Notary Signatu My Commission Expires 00 - to— ,Aw,9 <br />Printed Name County of Residence , <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 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:IZ <br />Constructio onager <br />4An BOARD OF PUBLIC WORKS APPROVAL Date: � �6� <br />Gary A. Gilot, President /ll�`� )`Suzanne NyFritzberd, Merler Elizabeth A. Maradik, Member <br />Therese J. Dor u, Member \ James A. Mueller, Member d M. Martin, Clerk <br />