PCA - Olive Road Lighting over the Indiana Toll Road Proj No 115-124 - Michiana Contracting, Inc.

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;o sourxp�o CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT ,.. PROJECT NAME Olive Lighting over the Indiana Toll Road PROJECT NO 115-124 FINAL COST $32,211.00 CONTRACT SIGNED 10/11/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Convert Olive Rd bridge liahtina to sinale phase power. WITNESSETH The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Executed is 7th. day of 2017 Michiana Contracting, Inc. ti Company Name Signature P.O. Box 929 Scott Wallsmith Company Address Name Plymouth, IN 46563 City, State, Zip WITNESSETS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Scott Wallsmith ,and acknowledged his/her signature to the above Project Completion Affidavit on tl:e 7th ddayooff Mar2017 Signature My Commission Expires March 27, 2022 Andrea Jae Fisher Printed Name County of Residence Marshall If the Contractor is a corporation, the following certificate will be executed. Scott Wallsmith , certify that I am Secretary of the Corporation executing this release; that Scott Wallsmith who signed this release on behalf of the contractor was then President of said Corporation; that said release was duly signed for and on behalf of said Corporativh by Aut ityof its governdy, and is within the scope of corporate powers: r� Z, Secretary's Signature Scott Wallsmith Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable far final approval and we recommend to the Board of Public Works that it be ordained so: Date: 3 . I • 1 `l Constructio onager Gary A. Gilot, President BOARD OF PUBLIC WORKS APPROVAL Suzanne M. Fritzberg, Member Therese J. Dora i, Member James A. Mueller, Member Date: b/7 Elizabeth A. Maradik, Member M. Martin,