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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />-Mishawaka Avenue - Roto-Rooter Jetter Removal <br />118-0169R (Division 1) FINAL COST $24,012.50 <br />7/10/2018 MAINTENANCE AGREEMENT ENDS <br />Removal of Rota -Rooter Jolter and hoses within the private lateral and the <br />sewer main on <br />Mishawrka Avenue <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 above Contract, <br />Execut is 1 y 0 to 201 8 HRP <br />Company Name <br />Signature - I ",-.J 5777 Cleveland Road P.O. Box 266 <br />Matthew D. Cain, President Company Address <br />Printed Name South Bend, IN, 46624 <br />City, State, Zip <br />WITNESSESS: <br />Matthe <br />Beforma <br />b � thmn e undersigned Notary Public in and for said country and state, personally appeared <br />w A and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 1 1Ah day Of O,t nh,-, 201 9 <br />Notary sjgnat&e My Commission Expires <br />Cimdy Vanheste <br />Printed Name <br />3/6,/24 <br />County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, Nancy Knapik certify that I am Secretary of the Corporation executing this release; that <br />Matthew D. Cain who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Socretary'd' eignatidre­ - Corporate Seal <br />Nancy Knapik <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable f 'r fi al approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: D <br />Construction ger <br />I — <br />lyk$l 44WAA <br />Gary A. Gilot, President <br />Therese J. Dorau. Member <br />BOARD OF PUBLIC WORKS APPROVAL Date: 4 t1d <br />Suzanna M. Fritzberg, Member <br />Jame <br />A. Muelrer, Member <br />t q <br />X 1=11,L <br />l�b <br />Elizabeth A. Maradik, Member <br />Fnda M. Martin, Clerk <br />