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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME -River Walk Subdivision Street Lighting <br />PROJECT NO 117-080 FINAL COST $47,990.00 <br />CONTRACT SIGNED 9/12/2017 MAINTENANCE AGREEMENT ENIDS <br />PROJECT DESCRIPTION Install liqhtinq foundations, conduit, and TESCO service within the River Walk subdivision, <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.` 201_2L TGB Unlimited d/b/a SfT Bancroft Electric <br />Nw Company Name <br />25020 IN-2 <br />Company Address <br />Printed Narfre South Bend, IN 46619 <br />City, State, Zip <br />WITNESSESS,: <br />Before the un�- rsigned Notary Public in and for said country and state, personally appeared' <br />and acknowledged his/her signature to the above Project Completion Affidavit on <br />the .201 �vLYNN SARTI f P0,1/,/ <br />of Indian <br />Notary Public, Stato <br />i Oporto C <br />na 6MfPlq*gRAMiWExpirO5 -1QV)"(',, <br />% <br />oullty <br />Notary Sig ,y <br />41nnwa'6 <br />Line 18, 2029 <br />Printed Name County of Residence J_z,�fi, ro <br />If the C,ontractola corpor n, the following certificate will be executed. <br />C, XJ <br />1)( 7T <br />C, o orc certify that I am Secretary of the Corporation executing this release; that <br />11-1 t.,vy1(.',Vn1-+' , who signed this release on behalf of the contractor was then <br />. ....... , hS 10 eil I- of said Corporation; that said release was duly signed for and on behalf of said z, <br />XC por atiby Authority of its <br />It . 'overning body, and is within the scope of corporate powers: <br />Secretary's Signature — <br />«2:4 Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable thr fin I approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction ttger <br />BOARD F PUBLIC I ORKS APPROVAL Date: PW <br />, U-5, <br />lo Al <br />-- Gary A. Gilot,'President --sdzann, a M. Ed(zberg, gerrifer Elizabeth A. aradik, Member <br />zl - - <br />Therese S—borau,rrnwr James A. Mueller, Member -"a M. Martin, Clerk <br />