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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />" rtli4 WM dM <br />CITY OF SOUTH BEND, INDIANA� <br />BOARD OF PUBLIC WORKSy <br />PROJECT COMPLETION AFFIDAVIT <br />School Zone Flashing Beacon Relocations <br />119-058 FINAL COST $9 800.00 <br />7/9/2019 MAINTENANCE AGREEMENT ENDS <br />Relocation of four 4 school zone flashing beacons within the City of South Bend, IN. <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 />Execu d this 30'th day ofOc Ober 2019 Michiana Contracting, Inc. <br />Company Name <br />Signature I PO Box 929 <br />® Company Address <br />Printed Name Plymouth, IN 46563 <br />City, State, Zip <br />WITNESSES: <br />Before me the undersigned Notary Public in and for said country and state, personally appeared <br />=ott - ° trick , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 30th day of Oct 201 9 <br />�. ANDREA JAE ,. <br />FISHER <br />tary S `lg`n,`a'turV My Commission Expires _ ff ta[ „ Seal <br />State of Indiana <br />Printed Name County of Residence Marshall County <br />�@ ,y�rrss�e�flirs5-�raaa-=� <br />If the Contractor is a corporation, the following certificate will be executed. <br />I„ Lisa Botto certify that I am Secretary of the Corporation executing this release; that <br />Scott Kirk trick who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on behalf of said <br />Cor by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />I <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable %or fi I approval and we recommend to the Board of Public Works that it be ordained so. <br />Pon <br />Date: 1 D. 2 Z• l <br />Constructi ger <br />BOARD OF PUBLIC WORKS APPROVAL Date: / " ) <br />7-1 <br />-bklf�l dz"6�s� --j U Q, <br />Gary A. Gilot,tgresia ent Geneyre�e E. Miller erhber Elizabeth A. aradik, Member <br />Therese J. Dorau, Member Lai.ara 'Sullivan, MrMber ,-,- i da M. Martin, Clerk <br />