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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME I/N Tek & I/N Kote Sanitary Sewer Chemical Ston <br />PROJECT NO. 114-051 FINAL 167,850.00 <br />COST <br />CONTRACT 06/28/2016 MAINTENANCE AGREEMENT <br />SIGNED ENDS <br />PROJECT Provide Calcium Nitrate Chemical Feed Systems at the Geyer Ditch Lift <br />DESCRIPTION Station (I/N Tek Sewer) and Sage Road Lift Station (I/N Kote Sewer) <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Execute this 3 I day of February 120 17 <br />,- —C Selge Construction Co., Inc. <br />Sign re Company Name <br />James Boyles, Vice ident 2833 S. 1Ith Street <br />Printed Name Company Address <br />Niles, Michigan 49120-4421 <br />City/State/Zip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and state, personally <br />James Boyles and acknowledged his/her signature to the above Project Completion <br />of the 3rd day f February 201 7 <br />Notary SignatureMy Commission Expires 07/25/2020 <br />Vicki A. Priest <br />Printed Name County of Residence BERRIEN <br />Q <br />MY COMMISSION Z <br />EXPIFES : Q' <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Vicki A. Priest certify that I am Secretary of the Corporation executing this release; t14at, <br />James Boyles who signed this release on behalf of the contractor was then <br />Vice President of said Corporation; that said release was duly signed for and on behalf of <br />said Corporation by AAority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signatdre <br />Vicki A. Priest <br />PrintedName <br />l;orporate Neal <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 <br />ordained so. <br />gm4a6 )If. 94a-4,� Date: oZ - /(o "2ol7 <br />Construction Manager <br />BOARD OF PUBLIC W/OI�KS APPROVAL Date:�a ��a0 (7 <br />i A • A <br />Gilot, Prelident Suzamna Nf Fritzberg,'Membe4 Janes A. Mueller, Member <br />Co. <br />'rnumNi� <br />A. Maradik, Member Therese J. D&au, Member L— I nda M. Martin, <br />