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ACKNOWLEDGED BY, the City of South Bend, Indiana Board of Public <br />Works, on this day of , 20. <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />President <br />i <br />E <br />E <br />Member <br />Member <br />STATE OF INDIANA ) <br />COUNTY OF } <br />Before ine, the undersigned, a Notary Public, in and for said County and State, personally <br />appeared <br />x <br />Known to me to be members of the City of South Bend, Indiana Board of Public Works and <br />acknowledged the execution of the foregoing Agreement on behalf of said Board. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name' and affixed my official <br />seal oil the day of , 20 . <br />(SEAL) <br />, Notary Public <br />Residing in __, Indiana <br />( This document was prepared by <br />I a0rm, under the penalties of petjufy, that I have taken reasonable care to redact each Social Security <br />i number in this document, unless required by law. (ha me) <br />(Aeknowledgement Page of City of South Bend, Indiana Board of Public Works) <br />