Project Completion Affidavit - Angela Bridge Lighting Project No 116-111 - Martell Electric LLC

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Si CITY OF SOUTH BEND, INDIANA�.,W'7'. BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT" PROJECT NAME Angela Bride Li htin PROJECT NO 116-111 FINAL COST $51,996.69 CONTRACT SIGNED 8/28/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Add liahtina on the Angela Blvd bridae. WITNESSETH The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Execut 't is day, f 201 Martell Electric LLC " Company Name &goal Are 4601 Cleveland Road ITC III I %� IQ A 1, A V1 Company Address Printed Name South Bend, IN 46628 City, State, Zip WITNESSES& Before me, the uraderss ned Notary Public in and for said country and state, personally appeared it and acknowledged his/her signature to the above Project Completion Affidavit on the . 11 day of , 20 Notary Signature My Commission Expires Printed Name County of Residence 6" If the Contractor is a corporation, the following certificate will be executed. I. certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable for r approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction ger BOARD OF PUBLIC WORKS APPROVAL tl 'Gary A. Gild ", President fAtre�Qve "% k, p-j #4nber Therese J. borau, Member Laura O'Sullivan, Member Date: o Elizabeth A. Maradik, Member inda M. Martin, Clerk