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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLE MON AFFIDAVIT <br />PROJECTNAME 2017 Riverside Sidewalk and Dri <br />PROJECT NO, <br />CONTRACT SIGNED <br />118-050 FINAL COST $2,224.40 <br />April 24, 2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Installation of sidewalk and driveway <br />WITNESSETTI: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Spec ificationsand Standards of the City of !�uth Bend which were a part of the above Contract, <br />Executed, its I--,-/ day 201 <br />TX Concrete <br />Company Name <br />24899 Fillmore Road <br />Printed Name Company Address <br />South Bend, In. 46619 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />-,>C156 j,r4,,'and acknowledged his/her signature to the above Project Completion Afflidavit on <br />the day of <br />or 20 <br />1v i�.; I (MIA E. MTH <br />NO,TAI,k,YPUBa,lCqQlXrE(Yits <br />ANA <br />ary Sig UlFe My Commission Expires ST , 10SEPH COk Nll�— <br />MY COMMISSION EXPRES 10110/118 <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />certify that I arn 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 duty 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 Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS, APPROVAL <br />This project is acceptable for final approval and we recornmend to the Board of Public Works that it be <br />ordained so. <br />Date: <br />ConstrucoiNanager <br />BOARD OF PUBLZICRKS APPROVAL Date <br />A/ ki <br />Gary A. Gilot, President su&ri`nff M. Friltzberg,vNqember <br />James A. Mueller, Member Therese J. Doran, Member <br />Elizabeth A. Maradik,­Membcr <br />I <br />st� <br />u—V k, ICY" <br />inda M. Martin; Clerk <br />