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'z <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME -East Bank Sewer Separation - Phase 5 (Division B) <br />PROJECT NO 114-0�62B FINAL COST $5,511,798.78 <br />CONTRACT SIGNED 1/26/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Separation of the storm and sanitary sewers along East Bank. <br />WITN'ESSETH: <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 whiere a part above Contract. <br />Executed thil d of CO Walsh Kelly Inc. <br />ch <br />Company Name <br />, South Bend Area <br />Name <br />WITNESSESS: <br />Before me, the undersigned Notary Public in <br />Dustin Hilary , and acknowledged,, <br />the 15th <br />ME <br />24358 State Road 23 <br />Company Address <br />South Bend, IN 46614 <br />City, State, Zip <br />and for said country and state, personally appeared <br />I ijAtUp r , ; Completion Affidavit on <br />ALISHA KBUEGE <br />P & ' <br />Nota(y Ribflc, state of Indiana <br />AL' st. Joseph county <br />My p9Go�mpp <br />mission Expires <br />Com <br />June 5, 2022 <br />Alisha Krueger <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />J. Michael Schaum <br />certify that I am Secretary of the Corporation executing this release; that <br />Dustin Hilary <br />who signed this release on behalf of the contractor was thVR�4i <br />South Berid—Area Managex., <br />of said Corporation; that said release was duly signed for and Orl"a hqg 0'jq <br />C poraronip)hority W verning <br />body, and nd is within the scope of corporate powers: <br />Secrete %nature <br />�hael <br />Co it Seat' <br />J. Schaurn <br />Printed Name <br />Zkl <br />A <br />DEPARTMENT OF PUBLIC WORKS APPROVAL jt <br />This project is acceptable for fin approval and we recommend to the Board of Public Works that it be ordalne&b'd.mW0 <br />Date: <br />Construction'§gdN <br />L�- <br />BOARD ;'UBLI WORKS PROVAL Date: I z/0' <br />Gary A. Gi;ilot, t5resident <br />n a F6(zberg, MemYbr Elizabeth A. Ma'6d!k, Member <br />Therese J. Dorft, Meffil5er <br />Jame A. Mueller, Member Lidda M. Martin, Cll"r <br />