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ACKNOWLEDGED BY, the City of South Bend, Indiana Board of Public <br />Works, on this day of , 2Q <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />President <br />Member <br />Member <br />STATE OF INDIANA ) <br />} SS: <br />COUNTY OF } <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally <br />appeared <br />a <br />known to me to be members of the City of South Bend, Indiana Board of Public Works and <br />acknowledged the execution of the foregoing Agreement on behalf of said Board, <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official <br />seal on the day of , 20 . <br />(SEAL) <br />Notary Public <br />Residing in Indiana <br />This document was prepared by <br />I affirm, under the penalties of perjury, that I have taken reasonable care to redact each Social Security <br />number in this document, unless required by lain. (name) <br />(Acknowledgement Page of City of South Bend, Indiana Board of Public Works) <br />