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w r f <br />CITY OF SOUTH BEND, INDIANA <br />q <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Olive Production Well #6 Rehabilitation <br />PROJECT NO. 118 102 FINAL COST <br />........................ _632.3Z. o....._ <br />CONTRACT SIGNED 11 /27/ 18 MAINTENANCE AGREEMENT ENDS <br />.. <br />PROJECT DESCRIPTION Cleanin and inspection of well #6 at the Olive Well Field <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 />Executed this 8th day of ._.�IM'Iaxic-IKI-,20 Lq <br />P ee r l es s -Mi dwe s <br />Signa# Ire Company Name <br />James R. Williams _ 5560 Russell Industrial Pkwy. <br />Printed Name Company Address <br />Mishawaka, IN 46545 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />James R. Williams _ and acknowledged his/her signature to the above Project Completion Affidavit on <br />....... 5 <br />CATHY S. LANCE <br />rto 8t day of Ma h .. 2019 <br />���,� <br />i w ' P xt� <br />,�rrrr�w w � Notary Public, State of Indiana <br />Notary Si tattire My Commission I� xpir St. Joseph counfv <br />h Lace ..WWw Y° ;n o t' �`' June 06 2023 <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I " cha el J. Williams its.........._, certify that I am Secretary of the Corporation executing this release; that <br />James R. Willi ams who signed this release on behalf of the contractor was then <br />General Ma n a e r of said Corporation; that said release was duly signed for and on behalf of said <br />o � <br />"orporalion by AWl arfty ofits governing body, and is within the scope of corporate powers: <br />S cae ry's Sagf)dtLll;e Corporate Seal <br />Michael J. ki,fliams <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 />tanstrLrc.............. Date: <br />C r "Manager <br />BOARD OF PUBLIC WORKS APPROVAL Date: . (,, pZo <br />Gary A,.t'3flot,Pres.dAi QeX Vv-reC-,! tlif-rl ,Member <br />ra L. O'StlH —'I''lierese J. Dorau, Member <br />l lrz�fbeth AMaradik Member <br />AltpA. <br />t ..IT. <br />"--]"Aida M. Martin, Clerk. <br />