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Home My WebLink AboutPCA - Demolition of Vacant&Abandoned Houses, Div B - Proj No 115-128B - Indiana Earth1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS August 23, 2016 Mr. Keith Stevens Indiana Earth, Inc. 10343 McKinley Hwy Osceola, IN 46561 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Demolition of Vacant & Abandoned Houses, Division B - Project No. l t5-128B Dear Mr. Stevens: 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 $145,930,00. 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 Di PROJECT NO 11 CONTRACT SIGNED 11 PROJECT DESCRIPTION DE WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Phase VIII Division B uu soRARU ' O� � \'gyp i 1855 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. Exec t ��,dayof Mki 201�. Indiana Earth, Inc. —�� Company Name gna ure 10343 McKinley Hwy Company Address MA-kK OnLA. eR SfD6n11— Printed Name Osceola. IN 46561 WITNESSESS:M�SSIo� Before me, the undersigned Notary Public in and for said country and state, personally appeared Sri oats„ and ack wledged his/her signature to the above Project Completion Affdavitar SEAL the _2%�i d of A- 201 i . z Notary Signature My Commission Expires Name County of ResidenceL�j,</i9—a" If the Contractor is a corporation, the following certificate will be executed. I, A4-U L ti SL6k— certify that I am Secretary of the Corporation executing this release; that �ij ir? abLt<�2 who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said Corpolq Ayfhority4 n body, ody, ancj is within the scope of corporate powers: fie (yam Ac-I Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceepta/bl for final approval and we recommend to the Board of Public Works that it be ordained so. Date: Constructior(!ghager BOARD OF PUBLIC WORKS APPROVAL Gary ary A. Gilot, President �i[ e4id P. Relos, bed Ther�rau, Me ber James A. Mueller, Member Date: 1 Y d 3 1 / E izabeth A Mar dik, Member Lin M. Martin, Clerk l WAIVER OF LIEN 1. The undersigned labors, mechanics, materialmen, suppliers, contractors and/or subcontractors ("Undersigned") entered into an agreement ("Agreement") with the City of South Bend ("General Contractor") to furnish labor, services, materials, and/or specially fabricated materials, etc., for the construction, improvement or repair of House Demolitions Proiect 115- 12E Ph. S ("The Project") located in the City of South Bend County of St Joseph , State of Indiana 2. In consideration of $ 7,296.50 and other good and valuable consideration, the receipt of which is hereby acknowledged, the Undersigned hereby waives and releases to the extent of such payment and in accordance with the terms contained in paragraph 3 below any mechanic's or materialman's lien or personal liability claims, public works claims and claims against any payment or performance bonds, or claim or right of such lien on the above -described premises and on improvements now or hereafter located thereon and which now exist or might otherwise arise because of labor, services. Or materials famished or to be famished by the Undersigned pursuant to the Agreement, 3. This lien waiver is a partial or final waiver and release of lien as provided below: (Check One) _ Partial release and waiver of lien X Full release and waiver of lien If this waiver of lien represents a partial waiver or release of lien, the amount of the unpaid balance due is 4. The Undersigned certifies that the materials and/or work covered by this application have been furnished in accordance with the contract documents, that all amounts have been paid by him for materials and/or work for which previous monies were paid, and the current payment shown herein is now due. 5. I have executed this waiver voluntarily and with full knowledge of my rights under the laws of the State of Indiana. The Undersigned is fully authorized to execute this document on behalf of the business so named. Given this 25th day of May , 20 16 . Mark Osler. President (Name & Title of Authorized Signer) STATE OF: Indiana COUNTY OF: St. Jospeh Signed and sworn to before me by Mark Osler this 25th day of May 2016. (NOTARYSEAL) Z,4�- Signature: Printed: Keith Stevens (Notary Publ My Commission Expires: 10/15/2023 County of Residence: Elkhart BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/14/16 Name Toy Villa ---vv 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 All 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: Required Information Company or Vendor Name Indiana Earth, Inc. New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Demolition of Vacant & Abandoned Houses — Division B Project Number 115-128 Funding Source COIT Account No. 404.1201.415.39.87 Amount $ 145,930.00 Terms of Contract Purpose/Description Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Change Orders Only Amount of ❑ Increase $ ❑ Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Dispersal After Approval Copy Original ® ❑ Elizabeth Maradik, Beth Leonard, Judy Love ® ❑ Mike Carey ® ❑ Toy Villa