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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT � <br />PROJECT NAME 2016 Manhole & Sewer Lining <br />PROJECT NO 116-026 FINAL COST $2,837,196.20 <br />CONTRACT SIGNED 12/22/2016 MAINTENANCE AGREEMENT ENDS <br />Lining of sewers and manholes to prevent inflow and infiltration and extend their service <br />PROJECT DESCRIPTION lives. <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 />ecuted this day of ' 201 Itlsotuforrn Technologies USA, LLC <br />w,IT Company Name <br />t626ale17988 Edison Avenue <br />JanetHass Company Addressontracting &Attesting Of w <br />............... <br />Printed Name Chesterfield, MO 63005 <br />City, State, Zip <br />WITNESSES& <br />fore me the undersigned Notary Public in and for said country and state personally appeared <br />wew and acknowledged his/her signature to on <br />I.AI,&I0% M. Ae 4[ <br />the day of 201 Not a y Public Pl+st,ar Seal <br />ittGf�riz������t1�Ri �k <br />L^" s <br />JL �I unty <br />�C� r�riti� I[ r? <br />x <br />btgry Signature My ComimispA"�rts <br />� y�y�,r✓p,. N <br />Printed Name County of Residence, <br />If the Contractor is a corporation, the following certificate will be executed. �» <br />certify that I am Set of the Corpora n executing is release; that <br />p 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 />Cor nation y' Authority o tsj, pverning body, and is within the scope of corporate powers: <br />creiarp's Signat6%stlanda Adkins <br />Contracting &Attesting Officer <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptableofin a roval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />..... <br />Construction er <br />BOARD PUBLIC WORKS APPROVAL Date: <br />Gary A. 61ot, President , n a ° t q b • Elizabeth A Maradik, Member <br />Therese J, P rainember James A— tm <br />Member " Linda M. Martin, <br />I Okvm 0'5L;1JiV" <br />