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UT <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKSNrx <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2017 Downspout Disconnect Program <br />PROJECT NO 116-114 FINAL COST $38,968.33 <br />CONTRACT SIGNED 1/24/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Remove downsvouts connected to the combined! sewer from willing resident dwellings <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 su n t and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />r rN hick were a part of the above Contract. <br />Of ruth Bend e <br />_ute day 'd t i" <br />Ex cuted this A Acorn Landscaping LLC <br />)/&/W ,2010 Company Name <br />Signature e,40F 4V <br />LINDA J GILROY 3680 W. Sample StY <br />"OtM111)" <br />P <br />Notary Public, State of lndia,a Company Address <br />% <br />St.JosephCoUnty <br />1 <br />Print Name <br />t5LAL; <br />Commission #62062 South Bend, IN, 46619 <br />My commission Expires City, State, Zip <br />Auoust 31, 2019 <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />az� and acknowledged his/her signature to the above Project Completion Affidavit on <br />the day of �UA 201 <br />Notary Signatrre, 717 My Commission Expires op -tP--261211y <br />ZZ �e (I-,, I.XU19y <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, 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 dully 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 project is acceptable for 'fala l pprova I and we recommend to the Board of Public Works that it be ordained so. <br />I <br />o--1 N11, Date: 'S <br />Construction M er <br />BOARD PUB7IC WOR APPROVAL Date: I <br />710 7/111- <br />Gary A. Gilo(",' President —8uzarffiW, WzYeWyemVer Priakatfi A Maradik, Member <br />Therese J. Dorhu, Member <br />James A. Mueller, Member <br />""Cin6a M. Martin, Chark <br />