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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />W ITN ESSETH: <br />y0UI1�Q <br />CITY OF SOUTH BEND, INDIANA ^��- <br />f x <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT' <br />IBv65� <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 < <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cit, <br />of South Bend which were a part of the above Contract. <br />Executed this fi+ day of ontn r, rft- 2016p Martell Electric, LLC <br />Company Name <br />Signat 4601 Cleveland Road <br />Company Address <br />Printed Name 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 />JQY1Y�i�er %3locA , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 7Ltth day of Q(xtU 6 C- t.. , 201 (-o <br />RE[iA B.A!D'NIN <br />Iltli , )11 C; �ndlP. f1B <br />Jc C, unry <br />Coro....s E <br />Notary Signature Myt ��mly� )d�F7�i - <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />-J-r SdSGPN <br />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 fgAfinal approval and we recommend to the Board of Public Works that it be ordained so. <br />V I JCS( Date: <br />s I Constructanager <br />BOARA OF PUBLICS WO (S APPROVAL Date: i i a � �� o <br />Gary A. Gilot, President 5�gQn,a H FtptiW9 Member Elizabeth A. Maradik, Member <br />Therese J. Dor u, Member James A. Mueller, Member Linch M. Martin, Clerk <br />