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SOUTgB <br />Ot /� <br />CITY OF SOUTH BEND, INDIANA <br />F/ <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />—abs <br />PROJECT NAME Ireland Road & High Street Intersection Im <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />10/27/2015 MAINTENANCE AGREEMENT ENDS <br />Remove the island on High st and install new traffic lights and pavement markings. <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 023 day of -J✓-I'e , 201 (P Reith-Riley Construction Co., Inc. <br />s Company Name <br />Signature 25200 State Road 23 <br />-.)45ku"4 / C(,OYr✓t6C� 3.1,�5 Company Address <br />Printed Name / South Bend, IN, 46614 <br />City, State, Zip <br />W ITNESSESS: <br />�efgreGmet thgCu}idersignd Notary Public in and for said country and state, personally appeared <br />i'I / mrG nd acknowledged his/her signature to the above Project Completion Affidavit on <br />the ` day of u,�b 201�. <br />Notary Signature My Commission Expires <br />Printed Name County of Residence <br />ro/aa/a a <br />If the C tractor' corporation, the following certificate will be xe uted. <br />I, e- I,* —,certify that I aecretary of the Corporation executing this release; that <br />Shuq4- W'eii""neej< who signed this release on behalf of the contractor was then <br />/r •e✓ 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 wi irithB 5&oL)e of cor orate powers: <br />�� SUE ANNE CIRA <br />SoN <br />Secretary's Sign .tore Nowy PUNC • $to of Iodlono Corporate Seal <br />i✓N 64k St Jotpn C" <br />Ct>mm�tbn EnM►a ow 22. 2 I22 <br />Printe Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />Q e , Date: G- l 8• l G <br />Construction M ager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />GaryA. Gilot, President David P.LRelos, Mem ems— Elizabeth A. Maradik, Member <br />/' v g I O" 1 �— L (� h tact <br />Therese J�Do au, Mt4nber Ja7s A. Mueller, Member — '4inda M. Martin, Clerk <br />