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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT m " <br />Mishawaka Ave Tree Replacement <br />118-111 FINAL COST $19 424.50 <br />11/20/2018 MAINTENANCE AGREEMENT ENDS <br />Installation of new trees and tree grates in the sidewalk on Mishawaka Avenue, <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by suc ontract, d that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of Sot h Bend whi h were a part of the above Contract. <br />xec ed this a of ACORN LANDSCAPING LLC. <br />y 201 _. <br />Company Name <br />Signatur" <br />I N DA J I L R ©Y 80 W SAMPLE <br />Notary Public, State of Indiaar rnpany Address <br />$t, Joseph County <br />Printed Name <br />y Commission A 629162 S DUTH BEND IN 46619 <br />4, :*` My Commission Expires ty, State, Zip <br />August 31, 2019 <br />WITNESSESS: <br />Map <br />Before 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 7A day of r <br />201 <br />Notary Signature <br />My Commission Expires <br />Printed Name <br />i <br />County of Residence cf'z (J-,!gxy <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, <br />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 <br />its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project I acceptbie or r approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction ager- <br />Gary A. Gilot, President <br />T rese J. Do , Merhber <br />P B t WORKS APPROVAL Date: I <br />E. Millen"ember Elizabeth A, Maradik, Member <br />O'Sullivan, <br />M. Martin, Clerk <br />