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CITY OF SOUTH BEND, INDIANA <br />Via' <br />BOARD OF PUBLIC WORKSz <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Mishawaka Avenue. - Roto-Rooter Jetter Removal Division 2 <br />PROJECT NO 118-069R FINAL COST $72 307.00 <br />CONTRACT SIGNED 7/10/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Removal and Replacement of elaht d'8'1 catch basins and inlets alono North Shore Drive <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�aa <br />js `C 5th dray of October , 201 8 <br />Signature <br />Robert Kuhns, Project Eh ineer <br />Printed Name <br />Sel e Construction Co., Inc. <br />Company Name <br />2833 S. 11 th St. <br />Company Address <br />Niles, MI, 49120 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />_Robert K�]Ytdas and acknowledged his/her signature to the above Project Completion Affidlpfloe a ... <br />the ... "1• t:h_ day o6 t ., 201 8 <br />Notary Signature My Commission Expires <br />Vicki A. Priest <br />Printed Name <br />NOTAF <br />PUBLIC <br />07/25/2020 MYCCMMISSioN <br />rsa <br />7 25-2G20 <br />Berrien �,� � I ��, N 6 <br />If the Contractor is a corporation, the following certificate will be executed. 'ps T11111 0' ry <br />I, Vicki A ft.............. — ....... _............ 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 />Prnj eat Engi neer of said Corporation; that said release was duly signed for and on behalf of said <br />Cor ration by Athori f its governing body, and is within the scope of corporate powers: <br />T <br />ocretary's Signat re <br />Corporate Seal <br />Vicki A. Priest <br />Printed Name <br />County of Residence <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for"fi al pproval and we recommend to the Board of Public Works that it be ordained so. <br />"" � Date: <br />Construction � a ,ger <br />Gary A. Gilot, President <br />BOARD OF PUBLIC WORKS APPROVAL Date. / / /,3 /�y (-1 <br />erg„ <br />Therese J. D rau„ ember James A. Mueller, Member <br />Elizabeth A. Mardik„ Member <br />,.° d14 <br />C�-..m. <br />Linda. M. Martin, Clerk <br />