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450UT g <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Colfax Avi <br />PROJECT NO 114-018A <br />CONTRACT SIGNED 3/8/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Install new street lighting, paint existing traffic lights, and re -stripe <br />W ITN ESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having been <br />completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever <br />arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and <br />Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 22 ncj day of U n e 201 62 <br />i <br />Printed Name <br />TGB Unlimited d/b/a S/T Bancroft <br />Electric <br />Company Name <br />25020 State Road 2 <br />Company Address <br />South Bend, IN 46619 <br />City, State, Zip <br />me, the undersigned Notary Public in and for said country and state, personally appeared <br />)&. ""1111 , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the ' d d, �'v 201_[Q <br />Lyw wt <br />Notary igndpvMy Commissio Expir s S I 2-3� Lit l� Vl n it t rotary <br />Laks Coemy <br />Printed N me County of Resi y commission,ExpaL,4d#8- 2023 <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, SC.CrN �cV)CV C certify that I am Secretary of the Corporation executing this release; that <br />fir r)-e Mann n✓1 who signed this release on behalf of the contractor was then <br />dice 00CVYihnnC- of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />n^ <br />PP Corporate Seal <br />SCOT- &InCi�;PJ <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable fo final approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: C, - I e - I <br />Construction ager <br />BOARD OF PUBLIC WORKS APPROVAL D Date: <br />�. <br />Gary A. Gilot, resident vid P. R�./ elos, Me eb r i a et A. Maradik, Member <br />rL — - cL,E.�-- <br />Therese J. DoWd, Mefnber Jam s A. Mueller, Member Liiri-dA M. Martin, Clerk <br />