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w� rera ,y <br />CITY OF SOUTH BEND, INDIANA r - <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2018 Tree Planting <br />PROJECT NO 118-048B FINAL COST $10,152.00 <br />CONTRACT SIGNED 10/9/2018 MAINTENANCE AGREEMENT ENDS <br />Furnishing and planting trees within the right of way at various locations within the City of South <br />PROJECT DESCRIPTION Bend, IN. <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 day, , 201 P. DOUGLAS LANDSCAPE, INC. <br />•, Company Name <br />Signature 23590 Ardmore Trail <br />Company Address <br />Printed a South Bend, IN 46628 <br />City, State, Zip <br />WITNESSESS: <br />are me, the undersigned Notary Public in and for said country and state, personally appeared <br />, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the day of 201�. <br />JUX JENNIFER L SCHULTZ <br />Notar&qnattWe My Commission Expires q-a7-1 q NOT,'.`�Y PUBLIC - OFFICIAL SEALOf mmt arrftTS4—,J 5 Count <br />My Comm. Expires September 27, 201 <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, 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 Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final. pproval and we recommend to the Board of Public Works that it be ordained so, <br />Date: l <br />Construction 04a4gell N, <br />OARD OF PUBLIC WORKS APPROVAL Date: . do,,1 <br />� a, <br />Gary A. Gilot, resident Sup 1 M. Fw'itzbergf111ka:r Elizabeth A. Maradik, Member <br />&4& <br />J Mueller Member <br />t, ALGA CZA... C: r Ve"eL <br />M. Martin, Clerk <br />