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m ia7a o,yt <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS ; <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Cleveland Well Field Retrvtn-bishn,ient _ Well Cleaning <br />PROJECT NO i 18-021C FINAL COST $48,598.00 <br />CONTRACT SIGNED 091/10/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION __SLJeaqin& ini ection rehabilitation, atL4not r re laceniei lrc�r Well 5 at � levelacl <br />WITNESSETH: North Well Field. <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 />Executed this 10th day ofDecember, 2019 Peerless -Midwest, Inc. <br />'A Company Name <br />Signature 55860 Russell Industrial Parkway <br />James R. Williams Company Address <br />Printed Name Mishawaka IN.: 46545 <br />City, State, Zip <br />WITNESSESS: <br />B f re, H e the �undtersigned Notary Public in and for said country and state, personally appeared <br />J e R Wi 1 i ama and acknowledged his/her signature to the above Project Completion Affidavit on <br />the th �� air of Deco bed, 2019. <br />.,.. �WAWNYtN,�rjf� <br />�wyre,r: CATHY S. LANCE <br />No ry Signature My Commi - 1� or Indiana <br />Notary State X„ m <br />`i aE* Y x pty <br />Printed N y Expires <br />Cat Name Ldnce Count of commission E <br />If the Contractor is a corporation, the following certificate will be executed, <br />I, Michael J . Williams certify that I am Secretary of the Corporation executing this release; that <br />James Williams who signed this release on behalf of the contractor was then <br />General manager of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation b ,Authq i't, o its governing body, and is within the scope of corporate powers: <br />WKI <br />� <br />Secretary' gnature <br />Michael J. Williams <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable f r at approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Constructi 9111 <br />ager <br />.. <br />Gary A. GiIoPr�esident <br />x <br />Therese J. d4fau, Mernber <br />BOARD OF PUBLIC WORKS APPROVAL <br />E. Miller, <br />Date: <br />Elizabeth A. Maradik, Member <br />nda M. Martin, Clerk <br />