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CITY OF SOUTH BEND, INDIANA F <br />1 <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT'°'; <br />PROJECT NAME Traffic Signal Detection Improvements <br />PROJECT NO 120-046 FINAL COST $113,668.80 <br />CONTRACT SIGNED 12/14/2021 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Upgrading of intersections traffic detection equipment at various areas throughout the City. <br />WITNESSETH: <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 day of F, 202JBL Signals and Lighting LLC <br />Company Name <br />Sature 4316 Technology Dr. <br />i1Q h �� L �0 Company Address <br />Printed Name V South Bend, IN 46628 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />r,j,n )n([-IP- L & I Sv t ) l,Tan-f acknowledged his/her signature to the above Project Completion Affidavit on <br />th t7 day of F k U q02 Y <br />Q/� <br />Rotary -Signature My Commission Expires <br />Printed Name County of Residence <br />tf the Qontractor is a corporation, the following certificate will be executed. <br />Debra A Urbanski <br />Notary Public Seal State of Indiana <br />St. Joseph County <br />Coam <br />My Commission Expires 03/09/2029 <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 />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: 2/26/2024 <br />Col traction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />�ffl <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: March 12, 2024 <br />