Laserfiche WebLink
CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Erskine Well #2 Rehabilitation <br />PROJECT NO ] 19.096 FINAL COST $62,000.00 <br />CONTRACT SIGNED 11/211g MAINTENANCE AGREEMENT ENDS <br />PROJECT <br />DESCRIPTION Clea..njn:,, lr ct on, a. d rehabilitation toy° Well 2 at Erskine Well Field. <br />WIT <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 18th day of dry�, 20120 <br />Signature <br />James R. William <br />Printed Name <br />Peerless -Midwest Inc. <br />Company Name <br />55860 Russell Industrial Pkwy <br />Company Address <br />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 />James R . Wi 1 l i am and acknowledged his/her signature to the above Project Complefion Affidavit on <br />the, 18t „ 2 <br />0 <br />WdayFebruary <br />CATHY S. LANCE <br />rc � Notary Public, State of Iraqi <br />Notary Signaturea <br />y <br />My Commission r6°'ANP $1, Joseph Goons; f <br />C t L n <br />S %�� My Commission t y,pi; ' � l; <br />" a 06, 2023 °r1 <br />vey Jun <br />Printed Name <br />County of Reside <br />If the Contractor is a corporation, the following certificate will be executed. <br />Michael J Williams <br />I . <br />certify that I am Secretary of the Corporation executing this release; that <br />James R. Wi 11 i ams <br />who signed this release on behalf of the contractor was then <br />General Manager <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation b A fl rit p <br />y of its governing body, and is within the scope of corporate powers: <br />ti <br />Secretary's Signature <br />Corporate Seal <br />Michael J. Williams <br />Printed Name <br />% DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is oce table or a ro we val and recommend to the Board of Public Works that it be ordained so. <br />P 1 PP Date: Z • Z • Z.C± <br />Constructio agar <br />m� <br />GaryM A. adotl�' resider i <br />