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CITY OF SOUTH BEND, INDIANA = <br />BOARD OF PUBLIC WORKS <br />r <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Downtown Mill and Asphalt Overlay <br />PROJECT NO 117-052r FINAL COST $205 825.25 <br />CONTRACT SIGNED 8/22/2017 MAINTENANCE AGREEMENT ENDS <br />Mill and resurface 1.5 inches of HMA surface pavement and provide thermoplastic pavement <br />PROJECT DESCRIPTION striraina and markinos for several downtown streets located in South Bend. <br />6�►y►lir�l tr��.1?.7�IIi:F <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend' which were a part of the above Contract. <br />Executed this day of � CLJ4 "" , 201 <br />Si nature ,1 <br />Printed Name <br />R`ieth-Riley Construction Co., Inc. <br />Company Name <br />25200 State Road 23 <br />Company Address <br />South Bend, IN 46614 <br />City, State, Zip <br />WITNESSESS: <br />Before me„ the undersignNotary Public in and for said country and state, personally appeared <br />.. 0s$rua A , ir'f`" r� �4^ d acknowledged his/her signature to the above Project Completion Affidavit on <br />the da °} ✓vim✓ 2017 <br />Notary Signature My Commission Expires <br />Printed Name County of Residence <br />If the ontract is a corporation, the following certificate will be ex c d. <br />I, ~� _ , certify that I arr"i�S ore &y of the Corporation executing this release; that <br />is G fmIC 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 h sc of •0r 0r to 0 l er <br />SUE A NE iCiRA <br />Sec etary''s Signature Soil <br />Notary public . State of Indians Corporate Seal <br />G+t 'C1l ► St Joseph County <br />Printed Name RIy Comfillisslon E Ires Utt 22'« 2022 <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project Is acceptable for al approval and we recommend to the Board of Public Works that it be ordained so. <br />.,.w ,. Date: k t <br />Construction tiger <br />BOARD 777 <br />APPROVAL [late: 541 r' c) � <br />Gary A. Gilot, President uzanna M. ktzbeK IM tuber Elize7eth A Maradik, Member <br />Therese J. Dor u, Member James A. Mueller, Member Linda M. Martin, Clerk <br />