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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT. <br />PROJECT NAME <br />2018 Downspout Disconnect Pro ram <br />PROJECT NO <br />118-014 FINAL COST $30,798.65 <br />CONTRACT SIGNED <br />3/27/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />Remove downspouts connected to the combined sewer from willinq <br />resident dwellinqs <br />WITNESSETH <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the 4�G c South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />(xecuted, <br />uch cone ot, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />were a part of the above Contract, <br />Ben which day of � 1;/ � , 201 Acorn Landscaping LLC <br />1.4 <br />�r" Company Name <br />Sig +�.„. ,�,r,xror starIkV J AANF07 <br />am eSt <br />tgry PubHo, Stny Address <br />fit. Jrrreh <br />Printed Name Commissionbtu""bernd, IN, 46619 <br />MY commission <br />�rN rw� July 1. ate, Zip <br />WITNESSESS: <br />Before me,the undersignedNotary Public in and for said country and state, personally appeared <br />gqir %"rand acknowledged his/her signature to the above Project Completion Affidavit on <br />the day Of. La 11 2X201�. <br />Notar Signature(` My Commission Expires <br />� �i <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, 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 />www_WWWW_W <br />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 />Secretary's Signature <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable for final pproval and we recommend to the Board of Public Works that it be ordained so. <br />Date: l I• l 3• 1yl <br />Construction er <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilol, President Gen vMeve E. Mill , Member Elizabeth A. Maradik, Member <br />Therese J. Dorau, Member <br />M. Martin, Clerk <br />