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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS, <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2017 Cold Milling <br />PROJECT NO 117-051 FINAL COST $51,129.59 <br />CONTRACT SIGNED 4/25/2017 MAINTENANCE AGREEMENT ENDS <br />Perform pavement cold milling services during the 2017 construction, season at various <br />PROJECT DESCRIPTION locations throughout the City of South Bend. <br />L011111111110� <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 y of De, e. 201 7 J1, Milling, Inc. <br />Company Name <br />Signature 15262 Industrial Drive <br />Company Address <br />Printed Name d( Schoolcraft, MI 49087 <br />City, State, Zip <br />WITNESSESS: <br />Before T.,5, the undersigned Notary Public in and for said country and state, personally appeared <br />Ilyk, 1-1XI 06 k 0 and acknowledged his/her signature to the above Project Completion Affidavit on <br />.201 av of14'?1 LC_ ­ <br />the <br />62 <br />ur My Commission Expires <br />31g <br />Name County of Residence <br />If the Contractor is a corporatio the lowing certificate will be executed, <br />I.Ll certify that I am Secretary of the Corporation executing this release; that <br />r <br />4, (4 XP who signed this release on behalf of the contractor was then <br />�,r_ e- v f 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 />SK g nature Corporate Sea] <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable I approval and we recommend to the Board of Public Works that it be ordained so, <br />Date: <br />Constructi eager <br />BOARD PUB WORS, APPROVAL Date: <br />Gary A. Gilot, President SuzafinaM, Fdtzbergvm r ber Elizabeth A, I ara !ik, Member <br />James A. Mueller, Member <br />Therese J. Dor4u Memberda M. Martin, Clerk <br />