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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS r r" 7, ✓ `� <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME FLIR Traffic Cameras Div.A,B C <br />PROJECT NO 117-122 FINAL COST $111,848.00 <br />CONTRACT SIGNED 12/21/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />WITNESSETH: <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 1 day of 20ts <br />L/ ignature <br />Printed Name <br />Pemberton Davis Electric, Inc. <br />Company Name <br />916 E. McKinley Ave. <br />Company Address <br />Mishawaka, IN 46545 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />the day oC J� g j kry ca�tbi VHAIMBAUGH <br />i �— St, and acknowledged histher signature to the above Project Indiana <br />-pat:3Pr� 201 Y State of <br />s ph County <br />SEq� Commisscoru # 632698 <br />MY CGMMr ssion 'as <br />Not Signature My Commission Expires " ` " Febrursr 0 0 <br />AM <br />Printed Name County of Residence <br />If the Contractor is a corporation, tjhe following certificate will be executed. <br />certify that I am 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 duly signed for and on behalf of said <br />Corporation by Aut city gf itygoveming body, and is within the scope of corporate powers: <br />Secretary's Signature - <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable fo fn approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: - 1 <br />Construction �rg�er <br />BOARD 0; PUB IC WORK AP ROVAL Date. 11,1131,4ca <br />._ 1 <br />�,"Y1,6i <br />Gary A. Gilot, iPr ident anna M, Fritzberg, Member eth A. Maradik, Member <br />Therese J. Dotau� em� <br />, ber James A. Mueller, Member —Linda M. Martin, Clerk <br />