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CITY OFSOUTH BEND, UNDUANA <br />BOARD 0FPUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Talais Royale Interior Painting <br />PROJECT NO 119055R FINAL COST <br />CONTRACT SIGNED 10/08/2019 mm|mTswAwosAGREEMENT smoG <br />PROJECT DESCRIPTION Interior painting in the Palajs-&'� 'g Li <br />The work under the above contract between the City of South Bend and the undersigned contractorhaving 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 />ofSouth Bend which were opart ofthe above Contract. <br />Company Name <br />Company Address <br />Printed Na e <br />City, State, Zip <br />VVITNEGGEGG: <br />Before me, t undersigned Notary Public in and for said country and otate, personally appeared <br />(A and acknowledged his/her signature to the above Project Completion Affidavit on <br />° uM <br />Notary Signature My Commission Expires <br />Printed Name <br />If thp rnntractor is <br />I. ------' <br />County of Residence <br />orporation, the following certificate will boexecuted. <br />certify that | am Secretary of the Corporation executing this release; that <br />Of A Q who signed this release onbehalf ofthe contractor was then <br />ufsaid Corporation; that said release was duly signed for and onbehalf ofsaid <br />i"firsgoveming bndy, and is within the scope of corporate powers: <br />Irma Marlow Galven <br />1:N : El <br />DEPARTMENT OFPUBLIC WORKS APPROVAL <br />This nV is acceptable fo( f i approval and we recommend to the Board of Public Works that it be ordained so. <br />Construction ?Vger BOARD OF PUBLIC WORKS APPROVAL Date: i <br />A, A, �'v ' 1Y <br />Gary A. Gilot, President Gene/vieve,, Miller, Memb X'Mara6ik, Member <br />Therese J. Ddrau, Member u ivan, Mern' er I i d a M. M a rti nz�C-1).i <br />