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bUiN <br />71, <br />CITY OF SOUTH BEND, INDIANA 0 <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME -Fellows Street Raised Crosswalk <br />PROJECT NO 117-086 FINAL COST $106,438.62 <br />CONTRACT SIGNED 11114/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Install a raised crosswalk near Riley HS on Fellows Street. <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,,--Avt as 201 Rioth-Riley Construction Co., Inc. <br />Company Name <br />Signature 25200 State Road 23 <br />Company Address <br />Printed Name South Bend, IN, 46614 <br />City, State, Zip <br />WIITNESSESS: <br />Before me, the un ersigned Notary Public in and for said country and state, personally appeared <br />^ <br />ksh wq4. / Aokd <br />acknowledged his/her signature to the above Project Completion Affidavit on <br />the -6�Ldayof 4A $-/- <br />201_y_, <br />y <br />Wotary Signature <br />My Commission Expires <br />51,Le Au rw a" <br />C-/ <br />County of Residence 11 <br />Printed Name <br />If the Contractor corporation, <br />the following certificate will be exeQuted. <br />1, 6 er et,., e- / ik <br />, certify that I am`6!N3cTdtary <br />of the Corporation executing this release; that <br />r 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 Autl1brity of its governing body, and is within h f o2orote—pow <br />SUE ANNE CiNA <br />Secretary's Sign urell <br />S"I <br />Notary Public - State of Indlans Corporate Seal <br />Em. <br />/,J <br />St Joseph County <br />F�rlriied Name <br />My Commission Expires Oct 22 2022 <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable far fire, approval and we recommend to the Board of Public Works that it be ordained so,. <br />JW <br />Date: —7, 0 1 it <br />Construction N'twiler <br />BOARD OF PUBLIC WORKS APPROVAL Date: . bcr <br />1 "' <br />041 <br />Gary A, Gilot, President <br />Suzadha M. Fritzborg, Member Elizabeth A. Maradik, Member <br />There�e J. Dorou, Member <br />James A. Mueller, Member U da M. Martin, Cler� <br />