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CITY OF SOUTH BEND, INDIANA��rr <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME FLIR Traffic Camera Replacements <br />PROJECT NO 118-006 FINAL COST $123,866.10 <br />CONTRACT SIGNED 2/13/2018 MAINTENANCE AGREEMENT ENDS <br />Remove existing traffic cameras and install FUR vehicle video detection systems at three <br />PROJECT DESCRIPTION intersections. <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 />Execu d 1 s d D 201 Pemberton Davis Electric, Inc. <br />Company Name <br />gnature 916 E. McKinley Ave. <br />Company Address <br />Wv <br />L'/<Printed Name 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 />9 <br />, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the day of <br />0—d-16 F� _ , 2018 <br />ca <br />Notaryignature <br />My Commission Expires �'u�,n¢" w, <br />1.,1-, <br />Ii/.lfi'.^ � '9'Y1 '!i �"d10J690.flv y'r"`� N;�^P7tlR2YSYe�J:H ry 6� <br />Printed Name <br />County of Residence fo r s"',`A"," <br />If the Contract r ia c <br />poratds o �, the following certificate will be executed. <br />, certify that I am Secretary of the Corporation executing this release; that <br />r 0 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 AuI <br />'ty of " s governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />project is This p acceptable for, pprovaland we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction tt <br />Eger <br />BOARD OF PUBLIC WORK4 APPROVAL Date: <br />Oil - <br />Gary A. Gilot„ President zjuzanna V. Fri berg, Member Ellabd h A. Maradik, Member <br />Therese J. um r,) er James A. Mueller, Member Linda M. Martin�CI rlc..,, <br />