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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 116-001 South Bend One-way to Two-way Conversion <br />PROJECT NO, 116-001 DIV B FINAL COST $17,849,70,7.77 <br />CONTRACT SIGNED 2/26/2016 MAINTENANCE AGREEMENT ENDS <br />Michigan Street / St. Joseph Street and Main Street from Ewing Avenue to Bartlett <br />PROJECT DESCRIPTION Street <br />WIITNESSETH: <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 61- day of Ala, K016 201 01y Rieth-Riley Construction CO., INC. <br />I <br />---P, Company Name <br />Signature 25200 State Road 23 <br />jCompany Address n� aw A. Avs z�tff—r <br />Printed Name South Bend, Indiana, 46614 <br />City, State, Zip <br />WITNESSES: <br />efore me, the undersigoied Notary Public in and for said county and state, personally appeared <br />o-s4t),i,4j1!S(A/V7t�,,Kand acknowledged his/her signature to the above Project Completion Affidavit on <br />the CQ H day o _ACV14 , 201 <br />-gIo-t Signature My Commission Expires <br />sve,4nn-e,fim <br />Printed Name County of Residence <br />/ 0 /a a --la a <br />If the Contract a corporation, the following certificate will be ex*uted. <br />5 e re <br />I, . Jvu QAe-l"k certify that iam e rsefa?y of the Corporation executing this release; that <br />SALT who signed this release on behalf of the contractor was then <br />=ks of said Corporation; that said release was duly signed for and on behalf of sari <br />Corporation by Adhority of its governing body, and is within the scolpe of corporate powers: <br />A <br />SUE E:A4NI 11"A <br />Se retar�'s �Si atuBe u SCSI <br />Notary Public • State of 71ndleng Corporal;. Seal <br />a 4V M Co 81 Joseph County <br />solon7 Expires <br />Oct 22. <br />Printed Name' M Cofffteolon Expires Oct 22. 2#;22 <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />Construction Manager <br />Gary A. Gilot, President <br />2-1 <br />erese J. Dorau, Member <br />Date: <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Suzanna M. Fritzberg, Member <br />James A. Mueller, Member <br />�HLL VLL�- <br />Elizabeth A Maradik, Member <br />Li M, Martin, CIerk <br />