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CITY OF SOUTH SEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT ? . <br />PROJECT NAME Edison Well #3A Rehabilitation <br />PROJECT NO 119-097 FINAL COST $62,350,00 <br />CONTRACT SIGNED 11/2612019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Cleaning, inspection, and rehabilitation for Well 3A at Edison Well Field. <br />WITN ESSETI-i: <br />The work under the above contract between the City of South Bend and the undersigned contractor having boon completed', <br />the City of South Mond, 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 21st day of April 20120 Peerless -Midwest, Inc. <br />Company Name <br />5 gnature 55860 Russell Industrial Parkway. <br />James R. Williams 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 />James R. Williams , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 1st of, April //:'1201 20 <br />G... pjr <br />r✓ � ,.. M 1 abM�g�Pit r°j"" ATHY S, tANCfc <br />Notary SignaturelfMy Commission Expires <br />Cathy S. Lance %Im �� sr_. JasPph cowlty <br />°e ti 1 omMnission Ex�irrss <br />Printed Name County of Residence I. °� ,; epl7 -111no n, 202 <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Michael 1. Williams _ certify that I am Secretary of the Corporation executing this release; that <br />James R. Williams who signed this release on behalf of the contractor was then <br />General Manager of said Corporation; that said release was duly signed for and on behalf of said. <br />Corporation b Authority of its governing body, and is within the scope of corporate powers: <br />��d� <br />Secretary" iegnature <br />Corporate Seal <br />Michael J. Williams <br />Printed Name <br />- <br />DEPARTMENT OF PUBLIC WORKS APPROVAL. <br />This project Is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />_ Date: 04/21 /2020 <br />Cnnstru on Manager <br />BOARD OF PUBLIC WORKS APPROVAL bate. April 28, 2020 <br />13C71XI2.D OF PL731LIC W C)I2ICS <br />Gary A. Gilot, President <br />Elizabeth A_ Maradik- Member <br />Therese J. Dorau, Merriber <br />Jordan V. Gathers, Member <br />ATTEST: <br />�IiZ.�CF C` �iR77712 <br />Joseph K. Molnar, Member <br />Linda M. Martin, Clerk <br />