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Home My WebLink AboutPCA - Indiana Earth, Inc. - Demo of Vacant & Abandoned Houses Phase VII Div B1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-I830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS September 13, 2016 Mr. Mark Osler Indiana Earth, Inc. 10343 McKinley Hwy Osceola, IN 46561 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Demolition of Vacant and Abandoned Houses, Phase VII, Division B — Project No. 115-117 Dear Mr. Osler: The Board of Public Works, at its meeting held on September 13, 2016, approved the Project Completion Affidavit for this project in the amount of $206,171.00. 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 W ITN ESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Phase VII Division B 171 10/27/2015 Demolition of Vacant and Abandoned Houses, Phase VII Division B 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. V day of SUC-y 201 G MMe r;SlxEZ VrZ�SF .ifr Printed Name Indiana Earth, Inc. Company Name 10343 McKinley Hwy Company Address Osceola, IN 46561 City, State, Zip WITNESSESS: Before me, the undersigned INry Public in and for said country and state, G Lb - , and cknowledged his/her signature to the above P the 24'L ay of ti i 201 �- Notary Signature My Commission Expires Lc-ttu S�JS Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. Y-- G�lE C Printed Name personally appeared certify that I am Secretary of the Corporation executing this release; that 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 07, and is within the scope of corporate powers: DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: —►• 2.S • I(, Constructio tmy Hager n / BOARD OF PUBLIC WORKS APPROVAL Date: zt� � h GaryA. Gilot, President DaVid P. Relos, Member Elizabeth A Maradik, Member Therese Dora , M&tber James A. Mueller, Member L' M. Martin, Clerk 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 famish labor, services, materials, and/or specialty fabricated materials, etc., for the construction, improvement or repair of House Demolitions Project 115- 117 Ph. 7 ("The Project") located in the City of South Bend County of St Joseph , State of Indiana . 2. In consideration of $ 67,860.95 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 furnished 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 often 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 29th day of Jul , 2016, (Name & Title of Authorized Signer) STATE OF: Indiana COUNTY OF: St. Joseph Signed and sworn to before me by Mark Oiler this 29th day of July 2 6. (NOTARYSEAL) Signature: Printed: Keith Stevens (Notary Public) My Commission Expires: _ 10/15/2023 County of Residence: Elkhart BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/19/16 Name Toy Villa Department Engineering BPW Date 09/13/16 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 ❑ I 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 I -I 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 Required Information Indiana Earth, Inc. ❑ Yes No If Yes I -I MBE I -I WBE LJ No ❑ Yes Name of Company Demolition of Vacant & Abandoned Houses, Phase VII — Division B 115-117 Blight Elimination 210.1060.460.39.82 $ 206,171.00 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Chanae Orders Onlv Amount of ❑ Increase ❑ Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ® ❑ U/0 U/0 Dispersal After Approval Beth Leonard, Liz Maradik, Judy Love Aaron Williams Toy Villa