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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />✓i�{,tiM7 Ay ��t' <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />$b <br />Lincoln Wav East Corridor Improvements — Sample to Tw ckenham <br />117-055A FINAL COST $501,696.36 <br />9/11/2018 MAINTENANCE AGREEMENT ENDS <br />............... <br />Improvements on Lincoln Wav East SR 933 between Sample Street and Twyckenham Drive. <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, anti hxhe contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend v hio " ere p of the above Contract. <br />Executed t of of _ t ry 20X 20 Walsh & Kelly, Inc. <br />Company Name <br />Printed Name <br />24358 SR 23 <br />Company Address <br />South Bend, IN 46614 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Dustin Hi,a and acknowledged Affidavit on <br />A, �x4 ;, ALISHA KRW GER <br />the 2 it ay Of _ F � 20X 20 � %�, Notary Public, State of Indiana <br />St. Joseph County <br />an'roirb+ N�rarg Expires <br />N ry Signature " <br />i irnmissiar)y4AifRs2022- <br />Alisha Krueger <br />Printed Name County of Residence St. Jse h <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Jamie L. Tancos certify that I am Secretary of the Corporation executing this release; that <br />Dustin Hiles/_ who signed this release on behalf of the contractor Nkm w ' I t Ill10 <br />VP f uth Bend Area of said Corporation; that said release was duly signed for an�th -�d <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: a <br />s Signature x t �� TF y <br />PQRA <br />ry' Secretary's mi ®� <br />ato at Seal <br />Jarde L. Tancos t <br />Printed Name ' <br />This rt ect'is acceptable? r al a DEPARTMENT OF PUBLIC WORKS APPROVAL + ' <br />p 1 p pproval and we recommend to the Board of Public Works that it be ordaine 'm <br />OL Date; <br />Construc . nager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gl ot, President J+ord< n athers„ Membe tabeth A. aradik, Member <br />Therese J. orau, Metb'r p iind—a M. Martin, Clerk <br />