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t <br />CITY OF SOUTH BEND, INDIANA 0 <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Ameritech Drive <br />PROJECT NO 117-057A FINAL COST $369,436,04 <br />CONTRACT SIGNED 6/26/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Road rehabilitation <br />WITNESSETH: <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 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 B ,pnywhich were a part of the above Contract. <br />,$1 , <br />Exect 4� is jq I 'e day of 201 0 <br />R,4 <br />Dustin I Li VP of South Bend Ares <br />Printed Name <br />,idsJ <br />WITNESSES& <br />J�eforp me the undersigned Notary Public in aria', se'i �oupfry and state, <br />Dustin Hiliryand acknowledged his/her sigrihOp to the above 1: <br />Walsh & Kelly <br />Company Name <br />24358 State Road 23 <br />Company Address <br />South Bend, IN 46614 <br />City, State, Zip <br />personally appeared <br />,qjqgL Completion Affidavit on <br />the 19th a of Ova <br />2018 <br />J7,71,'Al_1SHA KRUEGER <br />410 n Qry Pubk(" State of indt )1,1 <br />U n ol <br />7� <br />Notary'atute P! <br />2 <br />Alisha Kt-ueger 202 <br />June 5, 2022 <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />J. Mictmel Schaun 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 />VP nf ',qru&h P--Ynrl A-rn--i of said Corporation; that said release was duly signed for and on Pbhalf� of said <br />Corp f i overning body, and is within the -scope of corporate powem <br />Secret -S'SignatLA <br />ecr Corporate Seal <br />idelSchaun <br />J Zic <br />j <br />Printed Name % A I <br />DEPARTMENT OF PUBLIC WORKS APPROVAL 0, 6 <br />This project is acceptable to final approval and we recommend to the Board of Public Works that it be ordain e'r,so,�­` <br />4%^ Date: <br />Constructjctr�. hager BOARD OF PUBLIC WORKS APPROVAL Date: Jo f <br />Gary A. Gil -oh, President Suzanna M. Fritzberg, Member Elizabeth A. Ma'radik, Member <br />4These2J, �Dor Mem�i� James A. Mueller, Member Uida M. Martin, Clerk <br />