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CITY OF'SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2016, Bus Shelters <br />PROJECT NO 116-046 FINAL COST $1154,534,53 <br />CONTRACT SIGNED 1/24/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Install concrete pads and bus shelters. <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 />Execut this _j�_day of NovCok- Lx- , 201L_. Gibson -Lewis, LLC <br />Company Name <br />Signalure 1001 West 11 th Street <br />Company Address <br />A0 bee <br />Printed Name Mishawaka, IN 46544 <br />City, State, Zip <br />WITNESSESS: <br />Befor me, the undersigned Notary Public in and for said country and state, personally appeared <br />qcn Irafe, r' , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the clay of 201 <br />.NotJy Signature My Commission Expires <br />Printed Name County of Residence "J'Y"Mtn <br />If the Contractor is a corporation, the following certificate will be executed. <br />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 <br />Printed Name <br />Corporate Sea] <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This protect I. acceptable fir i ,%,accept bl f fl I approval and we recommend to the Board of Public Works that it be ordained so. <br />:�ay ., Date: <br />Construcflor�?r ,,+-ager BOARD OF PUBLIC WORKS APPROVAL Date: 1-,)IK,2 e-')l -7 <br />Gary A. Gillet, President David P. Relos, Member Elizabeth A. Maradik, Member <br />Therese J. Dotau, Member <br />James A. Mueller, Member <br />M. Martin, <br />