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CITY OF SOUTH BEND, INDIANA <br />F�.unre�rya� <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT e65 <br />PROJECT NAME Potawatomi Zoo Parking Lot Striping <br />PROJECT NO 115-129 B FINAL COST $4,598.75 <br />CONTRACT SIGNED 12/13/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Parking Lot Striping at Potawatomi Zoo <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 />Executed this �— day of(�✓ [ \a 201 DBL Services, Inc. <br />p, , e I/ Vt T Company Name <br />u�/S'-i�iggntaatture� ` t x r, x.� 1811 Clover Road <br />op"",0 L��L�r� Company Address <br />Printed Name Mishawaka, IN 46545 <br />City, State, Zip <br />WITNESSES: `—) Before me, the undersigned Notary Public in and for said county and state, personally appeared (nil <br />L C�( c..`�v2 , and acknowledged his/her signature to the above Project Completion Affi avit on <br />the .Q d y of , 201 FRANK C. LAWSON <br />PUBLIC <br />�, &Can"FF920224 <br />NOTARY PUBLIC <br />� STATE OF FLORIDA <br />No tar Signature My CommissionExpires <br />L,4a 4 �� C ` 4� - A) � r r� ExpiresCA,,, <br />1�119/2019 <br />Printed Na/me Y, L County of Residence f l�hr1l � l A V <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, 0^,YJ L j certify that I am Secretary of the Corporation executing this release; that <br />O v✓3 l Q who signed this release on behalf of the contractor was then <br />J r n �'t_s._yz ���� of said Corporation; that said release was duly signed for and on behalf of said <br />Cor oration by th It o rning body, and is within the scope of corporate powers: <br />Secretary's Signature <br />1 �+� Corporate Seal <br />0 "� <br />Printed Name L <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project forfin2l approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: Z . Z 3. 19 <br />Construction ager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gib, President Suzanne M. Fritzberg, Member Elizabeth A. Maradik, Member <br />A. Mueller, Member �- inpa M. Martin, Clerk <br />