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rfwr,a <br />CITY OF SOUTH BEND, INDIANA;' <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT;; <br />PROJECT NAME Edison Production Well #2A Rehabilitation <br />PROJECT NO, 118-103 FINA L COST $63,140.00 <br />CONTRACT SIGNED 11/27/18 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Cleanin and ins e.ction _o_f Well 2A Edison,n Well Fie_1_d�_ <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />r <br />Executed this 8th day of March .w 20 19-111111 <br />Signat re Company Name <br />uJames R. Williams 55860 Russell Industrial Pkwy <br />Printed Name Company Address <br />Mishawaka Il9 46545 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />" t Completion Affidavit on <br />Y —, g g d � . <br />James i i ams and acknowledged his/her signature to the above Pro ec <br />th th da of March 2019tw�rrsrrrwy <br />CAIHY S. LANCE <br />r " O,o AQ, « r, Notary Public, State of Indiana <br />Notary Sign° afire My Commission Expf 86A St. Joseph County <br />r Eb^G <br />Cathy S. Lance une 06, 2023 <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, M1 h el J.., lJj'I , certify that I am Secretary of the Corporation executing this release; that <br />JamesR. William <br />$ who signed this release on behalf of the contractor was then <br />Genera 1 fi n a gne r 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 />S cretary's Igna�nre <br />Michael , 'Williams Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be <br />ordained so. <br />" <br />Date: <br />Conslruc�ti anager <br />11 <br />BOARD OF PUBLIC WORKS APPROVAL, late" <br />I <br />de,-�-,Vieve F Mt'ltlW ;, Member <br />ra,L. O'Sullivan, Member Therese J. Dorau, Member <br />nqL-�, Utk <br />E izc ibeth A. Maradik, Member <br />`-f1 ida M. Martin, C -k <br />