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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <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 />2pn <br />endwhich were a part of the above Contract. <br />Executehis2 � a ust. 2019 D. C,_S ers Co./Detroit Inc. <br />Company Name <br />16429 Upton Rd. Suite #3 <br />Company_.� w <br />. DaVIS Address <br />Printed NamemW- East Lansing MI 48823 <br />City, State, Zip <br />WITNESSESS: <br />Before me the undersigned Notary Public in and for said country and state, personally appeared <br />to heMi J. Davis and acknowledged his/her signature to the above Project Completion Affidavit on t <br />Ill. Oth ay of, ALI t 2019 <br />KATHY. WOLCOTT <br />April 1 202 :POTARY PUBLIC . STATE f F MICIIIIGAN <br />Notary ignatur My Commission Expires p OF INOI IAIVI <br />Kathy 1 OI My Commission E'xpina ril t, 2023 <br />PrinteName IT Ingham Acting in the County of <br />County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I. Jamey Cie certify that I am Secretary of the Corporatlon executing this release; that <br />Ste I1en J. Davis who signed this release on behalf of the contractor was then <br />enefa Man8ler of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authonty of its governing, body, and is within the scope of corporate powers: <br />Secratary"sSignatump Corporate Seal <br />James Soett e° <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Thisrproject approval and we <br />o'ect is acceptable for Ir " I <br />Construction aarJer <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Mary A, Gilot, 'residen'ti Gen7q <br />wrimm <br />Therese J. bor t Pemger, 'Laura O'Sullivan, Mernber '• -Ainds M. Martin, <br />recommend to the Board of Public Works that it be ordained so. <br />Date: $ • 1$ l 4 <br />60 <br />