Laserfiche WebLink
CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS f �. ;1Q ` 4 <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Mishawaka Avenue Traffic Signals at Fire Station #9 <br />PROJECT NO 117-120A FINAL COST $172,146.57 <br />CONTRACT SIGNED 2/26/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Installation of preemptive systems at Mishawaka Ave/Ironwood Dr for Fire Station #9 <br />WITNESSETH: <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 />Exe uted this 14 day of )6rk4e^111l 2019 Pemberton Davis Electric, Inc. <br />Company Name <br />ignature 916 E. McKinle Avenue <br />a e� O Company Address <br />Printed Name Mishawaka, IN 46545 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />=fb►W and acknowledged his/her signature to the above Project Completion Affidavit on <br />the TN da of hgXd5 &g 201 q <br />Notary Signature My Commission Expires <br />Printedd tme County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I<ELLY M HAIMBAUGH <br />Not Public, State of Indiana <br />a <br />St Joseph County <br />V1y Commission Expires <br />February 02, 2020 <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 />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 />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable «f al approval and we recommend to the Board of Public Works that it be ordained so. <br />F"oft � <br />Date: �.:. __ • 1 <br />Constructio anager a <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilot, President GeneviiQE. Miller,, We—)We!rizabetti A. Mara ik, Member <br />Therese J. Dorau, Member L90fa L. O'Sullivan, Member Li da M. Martin, Clerk <br />