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� gAal'tll# qtp tl� <br />CITY OF SOUTH BEND, INDIANA,, <br />BOARD OF PUBLIC WORKS,, <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2019 Tree & Stump Removal <br />PROJECT NO 119-012 FINAL COST $24,743.00 <br />.... ...... <br />CONTRACT SIGNED 5/14/2019 MAINTENANCE AGREEMENT ENDS <br />Removal of trees and stumps in the right of way at various locations within the City of South <br />PROJECT DESCRIPTION Bend, IN, <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 day of 1 :!> „ 201 K&R Tree Service LLC <br />Company Name <br />SigiKature L 1724 S. Grant Street <br />VCompany Address <br />Printed Name South Bend, IN 46613 <br />City, State, Zip <br />WITNESSESS; <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Keu'jn • 4(, lNt / and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 9' rol day of e .f, s,` 201 <br />ary Signature My Commission Expires <br />tr <br />Printed Nay°wd'.VO <br />me County of Residence os <br />_. <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, certify that I am Secretary of the Corporation executing this release; tha �P* <br />la <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 sai' <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 />1'his project is acceptable for gal pproval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />too <br />Construction er <br />Gary A. Gilot, President <br />BOARD OF PUBLIC WORKS APPROVA <br />GehO'yieve E. Miller <br />rese J. Qbrau, Member f au�5`,O` ullivan„ <br />L <br />Date: A <br />�.. <br />- rza eth A. Macadik, Member <br />)w <br />0� da M, Martin, Clerk <br />