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Home My WebLink AboutPCA- Indiana Earth - Demo of Vacant & Abandoned Houses, Phase VII, Division C1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 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 C —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 $153,800.00. 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. MAR ADIK JAMES A. MUELLER THERESE J. DORAU SpUfNg CITY OF SOUTH BEND, INDIANA V'On BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT } PROJECT NAME Demolition of Vacant and Abandoned Houses, Phase VII Division C PROJECT NO 115-117 FINAL COST $153,800.00 CONTRACT SIGNED 11/27/2015 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Demolition of Vacant and Abandoned Houses, Phase VII Division C W ITN ESSETH: 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 s °' y of �V ( 201 Ci Indiana Earth, Inc. _ Company Name ignature 10343 McKinley Hwy v�� Pp� ��t�_ Company Address Printed Osceola, IN 46561 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared M, K g2�� L r and acknowledged his/her signature to the above Project Completion Affidavit on the day Vlr 201(�_. Notary Signature My Commission Expires Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. I, �2 L G5LG-IZ- certify that I am Secretary of the Cc �nt4lLK 031,�� who signed this release on behalf of the contractor was then VI�t�3li?IT of said Corporation; that said release was duly signed for and on behalf of said Co AutlF�ettt its a ing body, 0 is within the scope of corporate powers: Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable°for inal approval and we recommend to the Board of Public Works that it be ordained so. Date: '7 P- 1 t c, Construction Hager .._, Gary A. Gilot, President Therese J. Dor u,M#mber BOARD OF PUBLIC WORKS APPROVAL Date (, /-, ° J6 David P. Relos, M m e6 r Elizabeth A Maradik Member James A. Mueller. Member Linda 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 specially 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 $ _ 67.560.95 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 materialmon'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 furnished 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 lie, 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. 1 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 July , 2016 . (Name & Title of Authorized Signer) STATE OF: Indiana COUNTY OF: St. Joseph Signed and sworn to before me by Mark Osler this 29th day of July 2 (NOTARYSEAL) Signature: ,b 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 ❑ 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: 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 Required Information Indiana Earth, Inc. ❑ Yes ®No ❑ If Yes ❑ MBE ❑ WBE ❑ No ❑ Yes Name of Corn Demolition of Vacant & Abanc 115-117 Blight Elimination 210.1060.460.39.82 $ 153,800.00 Project Closeout e VII — Division C ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran. etc. Increase Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ❑ ❑ ® ❑ For Change Orders Dispersal After Approval Beth Leonard, Liz Williams 1&M Judy Love