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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Bowen Street Drainage Improvements <br />PROJECT NO 116-082A FINAL COST $53,958.60 <br />CONTRACT SIGNED 9/12/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Install four drywells on Bowen St. at Erskine Plaza <br />WITNESSETH: <br />The work under the above contract between the City of South Bend andthe undersigned contractor having been completed, <br />the City of South Bend * officials and 9gents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, aqd��h, t the contrac 6r performed the work within the scope of the Specifications and Standards of the City <br />of South Bend ch ere a p e above Contract. <br />Executed t 1 7st day 2017 Walsh & Kelly Inc. <br />of Company Name <br />Signature 24358 State Road 23 <br />Du tin � 11.,7South Bend Area Manager_. Company Address <br />Name 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 Hilary and acknowledged his/heroi Ah- QIEQ Q101i. t'Q tionr Affidavit an <br />ALISHA-KRIO EGER <br />the 21st ay, of Wovem�pr 2017 *P & <br />Notary Public, State of Indlani <br />S -AL: <br />r Sr. Joseph County <br />ii <br />My CoTmission Expires <br />Notary Sigaafurb� My't ,�, rei s s I o n EjWff@ F0 5 � 2.0 2 1) 61 5/22 <br />*t"W <br />Alisha Krueger <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed, <br />1, J. Michael Schaum certify that I am Secretary of the Corporation executing this release; that <br />Dustin Hilary , who signed this release on, behalf of the contractor was t <br />South Bend Area Manager of said Corporation; that said release was duly signed for and <br />61ion uthority efts vernling body, and is within the scope of corporate powers: <br />Y c 7 0 R <br />C-0gio A <br />-A <br />Secreta, y s 6ignature rate veal <br />J. Mi ael Schaurn <br />SEAL/ <br />Printed Name 1Z <br />'ZI <br />DEPARTMENT OF PUBLIC WORKS APPROVAL woe ...... <br />This project is acceptable for fin pproval and we recommend to the Board of Public Works that it be orZy6affi" to w00% <br />U-% Date: L2 <br />Construction,!78,6r _X) <br />BOA 7 OF PUITRLI C WORKS APPROVAL Date: <br />Gary A. Gild" President * -guAnha'M. Virilibefg, Me m-b6r Elizabeth Member <br />1� <br />Th6rese J. D(fau, Nimbler <br />James A. Mueller, Member <br />M'. Martin, Clerk <br />