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CITY OF SOUTH BEND, INDIA NA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Tint Street Brick Recovery <br />PROJECT NO. 1210-045 CDlT 75� Q2.....00 <br />.1T V 3,SS. <br />1 NCE At3REEIvIENT" I.,T <br />SIGNED <br />PROJE <br />ESCRIPTION Boulevard, deliver to ChN w arrd on West Calvert Street" t ��a' yctt <br />`k IT" ESSETH: <br />'Me work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of 'South Bend, its officials and agents are hereby released from all claims and. <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Execu d this day of....t e t rber , 2020 <br />A <br />w....:. . ..._......... �„alsh & I�eI Inc <br />Signature� ompany Flame <br />_i.Ynn ... Per ,,,........._ 243518 SR 23 <br />Tinted Name ompany Address <br />South Bend, III 414 <br />WITNESSES City/State/Zip <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />I-ynnJ.., Bauer � � �eacknowledged his/her signature� t t1) � r Yrnpletion Affidavit on <br />the th 'dayo ��e;,,SHA <br />PubIf r,dmKc, ¢af Vn1 m, <br />N�u9rrW�1 "' 5 7 e <br />auar`rw Signature 3 �issaorr �t ' r; m� 16/5122 <br />AtishaKru e M.n <br />Printed Name ounty of Residence TAph <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Jamie,L, Tpopor certify that I am Secretary of the Corporation executing this release; that <br />YN sued this release on behalf duly <br />e oontracto en <br />tell° t <br />Vp mi sub emti + arer tleiros of said Corporation; that said release was signed for anc <br />Co oration by Authority of its governing body, and is within the scope of corporate po. ........... <br />m `.'11u....., a ..t i.. , CAT <br />_. a ) <br />Secretary's Signature � � a � <br />.� F <br />uraie L. Tns <br />pn <br />ratedNaune DEPARTMN <br />ET OF PUBLICC�I.KS APPROVAL'''� / r'w <br />w• <br />,� Able ,w�� <br />"' <br />This project is acceptable for final approval and we recommend to the Board of Public ortast � tit be <br />ordained so, <br />BOARD OF PUBLJC. WORKS <br />(iaty A (plot, Presidmt <br />blvabetb A Maradik, Member <br />Date: <br />Th—r J. D—, kl-uber <br />Jordan V. Gathers, Member <br />111LSJ: <br />Date. October 13, 2020 <br />Joseph R. Molnar, Member <br />Linda M. Martin, Clerk <br />