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�uu var yA„q <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS. <br />PROJECT COMPLETION AFFIDAVIT P` <br />PROJECT NAME 2019 Community Crossing Div1-Corti , Div2-Jefferson, Div3-Linden, Div4-Riverside) <br />PROJECT NO 119-015 FINAL COST $1,076,412.33 <br />CONTRACT SIGNED 6/11/2019 MAINTENANCE AGREEMENT ENDS <br />Work to be performed shall include milling and resurfacing HMA surface pavement, pavement <br />PROJECT DESCRIPTION strip in, s and markings, and replacing cross ramps along these roadways. <br />_.W __...... ..-......... u <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, an hat the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend wnrere a part of the above Contract. <br />xecuted i� �- d F ��� 2019 _Walsh & Kelly, Inc. <br />„ Company Name <br />r91 24358 SR 23 <br />rs Ill Z. Company Address <br />Printed Name South Bend„IN 46614 <br />..................... <br />City, State, Zip <br />WITNESSES:. <br />Before tmethe undersigned Notary Public in and for said country and state, personally appeared <br />y and acknowledged his/her signature t tar oirs Go etion Affidavit on <br />v rsum OV91n"'Oft. � <br />^ALISHA KRwfE�[ <br />the day o'f 201 9 I { r a <br />', Y Public, State of Ind3�=-� <br />Note y" � rtatuee L," Si rJi raieoii Cro fr'�u .ail. <br />A <br />g "�4 ., ssi�a pir s , a Jm° <br />Allsha Krueger <br />5, 2022 <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, J. Michael Schaum certify that I am Secretary of the Corporation executing this release; that <br />Mtn Lujim who signed than release <br />rbehalf <br />lsi othe <br />contractor <br />wa �" tf lNl <br />l <br />of said Corporation° that said release was duy signed�� <br />Corpo dhorit overning�body„ and is within the scope of corporate powers: <br />Secreta sjSiginature " <br />" <br />J. " to Sell <br />W vie" Schatun ' <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL 1' <br />This project acceptable fit" f'al approval and we recommend to the Board of Public Works that it be orda}r 111, % <br />Date: JS <br />Constructio ages <br />BOAR <br />D P ILIC WORKS APPROVAL! Date:�� �o <br />f <br />Gary pv M f Ella e h A. Mara ik„ Member <br />Ga A. Gilot, President a <br />Therese J. D dyed, MerhberTo pil e I y9L4i...,' itrda M. Martin, Clerk <br />