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CITY OF SOUTH BEND,, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME -Western Avenue and Olive Street Intersection Improvement <br />PROJECT NO 115-097 FINAL COST $2,862,193.09 <br />CONTRACT SIGNED 5/9/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Construct improvements alono Western Avenue between Bendix & Olive. <br />M71101IM&1:11M <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 />Execule4 this 26th day of April 201 8 Selge Construction Co., Inc. <br />Company Name <br />71 <br />Signature 2833 S. 11 th Street <br />Robert S. Riley Project Manager Company Address <br />Printed Name <br />Niles, MI 49120 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Robert Riley , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 26th day of , =ii 1201 8 <br />-4- <br />Notary Signature My Commission Expires <br />Rql•_ 13 <br />Printed Name <br />County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, Vicki A. Priest certify that I am Secretary of the <br />. .. .... .. . .. Robert S, Rile y who signed this release on <br />Project Manager of said Corporation; that said release <br />C "rporation by A 041ty of its governing body, and is within the scope of corporat <br />07/25/2020 <br />xecuting this release-, that <br />1111� <br />#t%tor was then <br />'ed-f i �,on behalf of said <br />AR <br />PUBLIC <br />Secretary's Signature 1011 MY COMPISSION <br />0 EXPIRI F Corporate Seal <br />Vicki A. Priest 7 25 -.5-2020 <br />S, <br />Printed Name c 0. N\ <br />DEPARTMENT OF PUBLIC WORKS APPROVAL 11,,"M <br />This project is acceptable for fin approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: Z4. ad+ - 1 <br />Constructio alter <br />Gary A. Gilot, President <br />Therese J, D4r'au, Member <br />BOARD OF IPUBLIC WORKS APPROVAL Date: � 1 6 <br />Suzanna M. Fritzberg, Member <br />James A. Mueller, Member <br />Elizabeth A PvTaradik, Member <br />Li" dla M. Martin, ('Iprk'- <br />