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CITY OF SOUTH BEND, INDIANA �� y <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Lot 12 US 31 Industrial Park Asphalt Pavin <br />PROJECT NO 119-026 FINAL COST $35,975.00 <br />CONTRACT SIGNED 4/9/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Placement of HMA surface and striDina of Darkina lot. <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 Bend which were a part of the above Contract. <br />Executed this 18th day of June 201 9 Almac-Sotebeer, Inc. <br />Company Name <br />701"n <br />re 3414 CountyRoad 6 East <br />. C . Sotebeer Company Address <br />Printed Name Elkhart, IN 46515 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />John C . Sotebeer „ and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 18th day of June 201 9 <br />Notary Signature My Commission Expires <br />Kim M. Jennings <br />Printed Name <br />12/28/24 <br />County of Residence Elkhart <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, Jane Sotebeer certify that I am Secretary of the Corporation executing this release; that <br />John C . Sotebeer who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on behalf of said <br />Co oration by Auth rd of its governing body, and is within the scope of corporate powers: <br />Secre ry's Signature <br />Corporate Seal <br />Jane Sotebeer <br />Printed Name <br />� DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for "in approval and we recommend to the Board of Public Works that it be ordained so. <br />b <br />;, � � Date: . lei <br />Constructian ager <br />Elk - <br />Gary A. Gilot, resident <br />BOARD OF PUBLIC WORKS APPROVAL Date: 0 V " <br />Genevieve E. Miller, Member <br />Therese J. DoradKember � L. <br />aura O'Sullivan, Member <br />1AT_A'UJZ--- <br />Elizabeth A. Nkadik, Member <br />Tip a M. Martin, der <br />