Loading...
HomeMy WebLinkAboutPCA - Central Services Roof Replacement -Proj No 115-035 - Northern Indiana Roofing1316 COUNTY -CITY BUILDING 227 W. JEFFERSoN BOULEVARD SOUTH BEND. INDIANA 46661-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS August 23, 2016 Mr. Jan W. Sircey Northern Indiana Roofing & Sheet Metal 23495 Edison Rd. South Bend, IN 46628 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit— Central Services Roof Replacement — Project No. 115- 035 Dear Mr. Sircey: The Board of Public Works, at its meeting held on August 23, 2016, approved the Project Completion Affidavit for this project in the amount of $147,470.00. A copy of the Project Completion Affidavit is enclosed for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Linda M. Martin, Clerk Enclosure GARY A. GILOT DAVID P. RELOS ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Install roof replacement improvements according to the intent of the plans and specifications at the South Bend Equipment Services Building located at 1045 W Sample St, South Bend, IN 46619. The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Execute this= day of Ay Gy S f 201% Northern Indiana Roofing & Sheet Metal 7reSt�QenF Company Name Sign t re Q 23495 Edison Rd 'TA r,.) k s t ti C E"{ Company Address Printed Name South Bend, IN 46628 City, State, Zip W ITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appearedand acknowledged his/her signature to the above P the 2 4 day of t GJ s i , 201 lP of gnatureg� My Commission Expires LLPC) A tL 5C2i T30 Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. �r4AiD / A N P`\\\``,� I, KC-�-K,4 G r•o v certify that I am Secretary of the Corporation executing t 111W$8+e; that T� r, w • S', r ce ti who signed this release on behalf of the contractor was then I, S : e . z of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's nature Kcrlkv fpOYNS Corporate Seal Printed Natne DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptabl fo final approval and we recommend to the Board of Public Works that it be ordained so. Date: i- 18 • 1 tr Constructi anager BOARD OF PUBLIC WORKS APPROVA Gary A. Gilot, President Vivid P. Relos, tuber There/ se J. D rau; fvlember James A. Mueller; Member L Date: Elizabeth A vlaradik, Member Linda M. Martin, Cler Liberty _Mutual_. SURETY MAINTENANCE BOND 601108718 KNOW ALL MEN BY THESE PRESENTS, that we, Northern IN Roofing & Sheet Metal Corp. 23495 Edison South Bend, IN 46628 as Principal, and West American Insurance Company , as Surety, are held and firmly bound unto (hereinafter called the Obligee), in the penal sum of Fourteen Thousand Seven Hundred Forty-eight Dollars And Cents ON for the payment of which, well and truly to be made, we do hereby bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Dated: 8/8/2016 WHEREAS, the said Principal has heretofore entered into a contract with the Obligee for City of South Bend Board Public Works, Central Services Roof Replacement Equipment Services Building and, WHEREAS, the work called for under said contract has now been completed and accepted by said Obligee; NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall for a Principal shall for a period of 3 years from and after the date of the completion of the contract indemnify the Obligee against any loss or damage directly arising by reason of any defect in the material or workmanship that may be discovered within the period aforesaid, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED, HOWEVER, that in the event of any default on the part of the Principal, written statement of the particular facts showing such default and the date thereof shall be delivered to the Surety by registered mail, at its home office in the city of Indianapolis. Indiana promptly and in any event within ten (10) days after the Obligee or his representative shall learn of such default; and that no claim, suit or action by reason of any default of the Principal shall be brought hereunder after the expiration of thirty days from the end of the maintenance period as herein set forth. Northern IN Roofing & Sheet Metal Corp., 23495 Edison Rd., South Bend, IN 46628 West American Insurance Company S-177 POWER OF ATTORNEY West American Insurance Company Bond Number:601108718 Principal: Northern IN Roofing & Sheet Metal Corp., 23495 Edison Rd., South Bend, IN 46628 Agency Name: DeHaves Group Obligee: Agent Code:130178 Know All Men by These Presents: That West American Insurance Company, pursuant to the authority granted by Article IV, Section 12 of the Code of Regulations and By - Laws of West American Insurance Company, do hereby nominate, constitute and appoint: Sandy Roth, Mindy Zielke, Heather R. Pieper, Donald H. Stonebumer, David Relue, Jeff Pike], Emily Kitchens, Karen S. Wallace, Martha Kinast, Renada Kelley of FT WAYNE , Indiana its true and lawful agent(s) and attomey(ies)-in-fact, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, excluding, however, any bonds) or undertaking(s) guaranteeing the payment of notes and interest thereon. And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Company, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of said Company at their administrative offices in Indianapolis, Indiana, in their own proper persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attomey(ies)-in-fact. In WITNESS WHEREOF, the undersigned officer of the said West American Insurance Company has hereunto subscribed his time and affixed the Corporate Seal of said Company this 18th day of November, 2013. y tNSU� G o0.voRq 'Y r'� D d'rr ry°NP *�d David M. Carey, Assistant Secretary STATE OF PENNSYLVANIA COUNTY OF MONTGOMERY On this 18th day of November, 2013 before the subscriber, a Notary Public of the State of Pennsylvania, in and for the County of Montgomery, duly commissioned and qualified, came David M. Carey, Assistant Secretary of West American Insurance Company, to me personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn deposes and says that he is the officer of the Company aforesaid, and that the seat affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Plymouth Meeting, State of Pennsylvania, the day and year first above written. 6P PAST Q��yoNWp, F(� COMMONWEALTH OF PENNSYLVANIA / Notarial Seal Teresa Fee."., Notary Publi OF Q' Plymouth Twp., Montgomery County My Commission Expires March 2fi.201] c/ Notary Public in and for County Montgomery, State of Pennsylvania Apy P� Member, Pennsylvania Assoclellon of Notaries My Commission expires March 28, 20172017 8, This power of attorney is granted under and by authority of Article IV, Section 12 of the By -Laws of West American Insurance Company, extracts from which read: ARTICLE IV - Officers: Section 12, Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bond, recognizarms and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers ofattorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of directors of West American Insurance Company effective on the 15th day of February, 2011: VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a certified copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company with the same force and effect as though manually affixed. CERTIFICATE I , the undersigned Assistant Secretary of West American Insurance Company, do hereby certify that the foregoing power of attorney, the referenced By -Laws of the Company and the above resolution of their Board of Directors are true and correct copies and are in full force and effect on this date. IN WITNESS WHEREOF, I have hereunto set my hand and the seal of the Company this 8th day of August 1 2016 a \NSUq WQ� 3° Fo F Y � �bJ rNpIPNP as * 1• Gregory W. Davenport, Assistant Secretary CONTRACTOR'S AND SUPPLIER'S AFFIDAVIT AND WAIVER OF LIEN X Final Partial Payment to follow The undersigned, being first duly sworn on his oath or affirming, states that: 1. Jan W. Sircey (name) is the President (Title) of Northern Indiana Roofing & Sheet Metal Corp. (Company), (hereinafter called "Company" of and is familiar with the facts herein stated and makes this affidavit for and on behalf of himself and the Company, being duly authorized to bid the Company by the Statements herein contained. 2. The Company having contracted with City of South Bend, has preformed work and labor or furnished materials supplies or equipment in the construction of certain improvement on the real estate commonly known as South Bend Central Services in South Bend (City), Indiana which real estate is owned by Cith of South Bend (hereinafter called "Owner"). 3. Company has, or will within 10 days of receipt of payment due from Owner noted in item 4, paid for all work, labor, materials, equipment, and supplies performed or furnished by it and by its subcontractors, material - men and supplies upon such premised or in connection therewith and no person, other than Company, has any claim or right to a lien for any work, materials or services on account of any transaction undertaken by Company with respect to said premises, except as specially noted below: Name of Company Amount Owed Explanation for Withholding Payment 4. The amount due Company from Owner: PARTIAL WAIVER that the balance due is the sum of. Dollars ($ receipt of which is hereby acknowledged, or, the payment of which is promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. FINAL WAIVER that the final balance due is the sum of: Thirty -Five Thousand Three Hundred Ninety -Two and 80/100 Dollars ($ 35,392.80 ) receipt of which is hereby acknowledged, or, X the payment of which is promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases under the statutes of the state of Indiana, unto the Owner of said premises, any and all lies of claim whatsoever on the above -described property and improvements thereon account of LABOR or material or both, furnished by the undersigned thereto, and further certifies that no other party has any laim or right to a lies on account of any work performed or material furnished to the undersigned for said oject,/except as ted above, and within the scope of this affidavit and waiver. By: !�✓ Title: President WITNESS MY HAND AND NOTARIAL SEAL, this 2nd day of Au¢ust, 2016. My Commissio xpires: Aril 3, 2018 County of Residence: Allen (Not ub BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/15/16 Name Toy Villa Department Engineering BPW Date 08/23/16 Phone Extension 5920 Required Prior to Submittal to Board Legal ❑ Attorney Name Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the Appropriate Item Type — Required for Ail Submissions ❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Change Order No. ❑ C/O & PCA No. ® PCA ❑ Ease/Encroach. ❑ Traffic Control ❑ Other: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of Kequired Intormation Northern Indiana Roofinq & Sheet Metal ❑ Yes N No ❑ If Yes, Approved by Purchasing ❑ MBE ❑ WBE ❑ No ❑ Yes Name of Company Central Services Roof Replacement 115-035 Central Services Capital 224.0605.419.42.10 147,470.00 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Increase Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ❑ ❑ For Change Orders On Dispersal After Matt Chlebowski Villa