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Home My WebLink AboutChange Order-PCA - 2016 Yard Lamppost Program - Proj No 116-003 - Martell Electric LLC1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS November 22, 2016 Jennifer Brown Martell Electric, LLC 4601 Cleveland Road South Bend, IN 46628 RE: Change Order No. 2 (Final)/Project Completion Affidavit 2016 Yard Lamppost Program Project No. 116-003 Dear Ms. Brown: PHONE 574/235-9251 FAx 574/235-9171 The Board of Public Works, at its meeting held on November 22, 2016, approved the Final Change Order for this project, for a decrease of $1,000. The new Contract sum is $20,250.00. In addition, the Project Completion Affidavit for this project was approved in the amount of $20,250.00. Copies of the Change Order and Project Completion Affidavit are 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 Enclosures c: Toy Villa, Engineering Kevin Fink, Engineering GARY A. GILOT SUZANNA M. FRITZBERG 0_h_tL'L ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU SouTgg CITY OF SOUTH BEND INDIANA ; J DEPARTMENT OF PUBLIC WORKS �C�> .�� PROJECT CHANGE ORDER ,as, DATE: 10/12/2016 PROJECT NO: 116-003 PROJECT NAME: 2016 Yard Lamppost Program CONTRACT DATE: 3/8/2016 CHANGE ORDER NO: 2 (Final) SUBJECT OF CHANGE ORDER: PCR #2-Final Quantities All items completed substantially as planned. See attached Comparison of Estimate for overruns and underruns. The original contract sum $ 102,250.00 Net change by previously authorized change orders $-81,000.00 The contract sum prior to this change order $ 21,250.00 By this Change Order, the project amount is ❑ Increased The new contract sum including this change order This Change Order represents a total change of Total change for entire project Original contracted completion date/time Extension of date/time by previous change orders Date/time extension by this change order New completion date/time CONTRACTOR am4�� Cont�..or Printed Name and Tide Martell Electric, LLC Company Name 4601 Cleveland Road Address South Bend, IN 46628 City, State, Zip ❑X Decreased $ 1,000.00 $ 20,250.00 -4.71 % -80.20 % 0 days 11/15/2016 RECOMMENDED FOR APPROVAL --T- CONST TION MANAGER CITY OF SOUTH BEND BOARD OF PUBLIC W RKS Approved D jf ;�(jo lc, Gary A. Gilot, President Suz.w. A m.Member Elizabeth A.Ma�radik, Member �y Therese J. Do u, M4mber James A. Mueller, Member PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION W ITN ESSETH: y0UI1�Q CITY OF SOUTH BEND, INDIANA ^��- f x BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT' IBv65� 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 < by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cit, of South Bend which were a part of the above Contract. Executed this fi+ day of ontn r, rft- 2016p Martell Electric, LLC Company Name Signat 4601 Cleveland Road Company Address Printed Name South Bend, IN 46628 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared JQY1Y�i�er %3locA , and acknowledged his/her signature to the above Project Completion Affidavit on the 7Ltth day of Q(xtU 6 C- t.. , 201 (-o RE[iA B.A!D'NIN Iltli , )11 C; �ndlP. f1B Jc C, unry Coro....s E Notary Signature Myt ��mly� )d�F7�i - Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. -J-r SdSGPN 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 Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable fgAfinal approval and we recommend to the Board of Public Works that it be ordained so. V I JCS( Date: s I Constructanager BOARA OF PUBLICS WO (S APPROVAL Date: i i a � �� o Gary A. Gilot, President 5�gQn,a H FtptiW9 Member Elizabeth A. Maradik, Member Therese J. Dor u, Member James A. Mueller, Member Linch M. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of St Joseph SS: Jennifer Brown being duly sworn that he/she is the �f-ice President (Name of Officer) (Title) Of Martell Flecirjrl I I r having contracted with _City of South Bend (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: �Irt4raL (Description) for a project known as 2016 Lamppost ost Program (Name of Project) located at and owned by (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars ($ ) ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of -Fourftiisarr&-7&1-00 4218.76 ) ❑ receipt of which is hereby acknowledged; or ] the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a lien on account of any work performed or waicriai furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. Martell €leGtrie1F66C---- -- By it (Finn) Authorized Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Jennifer Breverr and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the -R 157 day of OC2tD PJf Q' — — 201(o Notary Public Signature My Commission Expires: ��® Z pZ -6 Residing in %�_ SQ�N County, jQ Not Pb, me RENABALDWIN u� �' s •"'•' tl ovary Pu b'i C. State of Indiana 'oo�n9i'• '_ Si.:os,-oh Coumy :a= $EAR COO1 nL 6'.uL1 U GJJ)''C M•. Convni r. n c-.64 Uiws ",",°'„;o°' Eebruair 28, 2023 AFFIDAVIT AND WAIVER OF LIEN 2 Final ❑ Partial F] Payment to Follow STATE OF: Indiana COUNTY OF: St. Joseph Jennifer Brown being duly sworn, deposes and says that __he makes this affidavit for and in behalf of MARTELL ELECTRIC, LLC which, having entered into an agreement with City of South Bend ("Contractor") for the construction of 2016 Lamppost Program on the premises of the owner located at various locations states that, upon receipt of payment by Martell Electric from Contractor in the amount of Four thousand two hundred eighteen & 75/100 Dollars, (the "Payment"), which payment has been promised by Contractor and is anticipated by Martell Electric, all material and subcontract, due and payable, will have been paid and all labor paid in full to the date of this affidavit EXCEPT for: CONTRACT RETENTION S Effective upon receipt by Martell Electric of the Payment, Martell Electric does waive and release unto the owner of said premises, any and all lien, right of lien or claim of whatsoever kind of character on the above -described building and real estate under the Statutes of the State of Indiana relating to Mechanic's liens, on account of any and all labor, material, or both, furnished for or incorporated into said building by the undersigned, up to this date. Subscribed and sworn to before me, on this 31st day of October, 2016 Notary Public My commission expires: 2/28/2023 MARTELL ELECTRIC, LLC (si ned) Jennifer Brown (Printed Name) Vice -President (Title) R E N A B A L D W I N $IHiY O ft(j1711� Go,i,•.,y •. SEAA. - Cosani,.'; rJn A Gil L:GS4 . L4; Canro�u: r,on C;;Otra3 Fobfuary 28, 2C28 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/10/16 Name Toy Villa Department Engineering BPW Date 11/22/16 Phone Extension 5920 I Required Prior to Submittal to Board l 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. 2 Final ❑ 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 Required Information Martell electric, LLC ❑ Yes No ❑ If Yes Approved by Purchasi I -I MBE I -I WBE LJ No ❑ Yes Name of Company 2016 Yard Lamppost Prooram Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination. Non-Dehnrmant F-Verifv Iran Af, For C Amount of ❑ Increase $ ® Decrease $ 1,000.00 Previous Amount $ 21,250.00 Current Percent of Change: 4.71 % New Amount $ 20,250.00 Total Percent of Change: 80.20% Dispersal After Approval Copy Original ® ❑ Kevin Fink ® ❑ Toy Villa ❑ ❑ On