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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />Colfax Avenue and <br />and <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 />n�L- <br />Execute this day of Ju,. L 201 % L.L. Geans Construction Co. <br />Company Name <br />Sign r /- 1905 Elder Rd <br />V 'R- C7eaat �. r d�f Company Address <br />Printed N me Mishawaka, IN 46545 <br />City, State, Zip <br />W ITNESS ESS: <br />theywr m h undersigned Notary Public in and for said country and state, personally appeared <br />L, /, and acknowledged his/her signature to the above Project Completion Affidavit on <br />aayof _ a 201 <br />Not ign tl'e ' My Commission Expires �I/b3/Zbj� <br />Printed NaMe County of Residence , .2(XP�k <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, �Ga �e_.� C •Cl , certify that I am Secretary of the Corporation executing this release; that <br />0 ( . G ri S who signed this release on behalf of the contractor was then <br />Prs i cltki l— of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of it overning body, and is within the scope of corporate powers: <br />Secreta Signature <br />Corporate Seal <br />GZQ_V\ -�- 0-- Gcos <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable fokfinal approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: (e • I a • i 4 <br />Construction Hager � I <br />BOARD OF PUBLIC WORKS APPROVAL Date: %! <br />Ga A. Gilo , resident DaMd P.LR,elos, Member Elizabeth A. Maradik, Member <br />Therese J. DffraLWember Jagnes A. Mueller, Member t'inda M. Martin, Cle k <br />