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222457 <br />PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />Multi -Component Striping <br />122-065 FINAL COST $16,580.77 <br />12/20/2022 MAINTENANCE AGREEMENT ENDS <br />City of South Bend MC Striping Chippewa & Michigan Intxn <br />The work under the above contract between the City of South Bend and the undersigned contractor having been <br />completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever <br />arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and <br />Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 28th day February 2024 <br />Signature <br />Brian Triska, President <br />Printed Name <br />Traffic Control Specialists, LLC <br />Company Name <br />1810 W. Pacific Ave. <br />Company Address <br />Knox, IN 46534 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Brian Triska , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 28th day of February 12024 <br />Notary Signature My Commission Expires <br />Dawn L. Bennett <br />Printed Name <br />County of Residence <br />\AY ' , <br />DAWN L. BENNETT <br />o•••••�s'c Notary Public, State of Indiana <br />10/2 <br />12U�AL• - <br />Starke County <br />i ' nN u mb-rNP0723106 <br />i' •'Np,; <br />My Commission Expires <br />October 20, 2027 <br />Stark <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, certify that I am Secretary of the Corporation executing this release; that <br />who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Printed Name <br />Corporate Seal <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 />Ala& .L. 4al. eLtt- Date: 2/29/2024 <br />Co&fstruction Manager <br />President <br />Member <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Member <br />Member <br />Member <br />Member <br />