The URL can be used to link to this page

Home My WebLink AboutPCA - Century Center Electrical Distribution Upgrades - Proj No 116-007 - Days Corporation1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 Nate Carpenter Days Corporation 55169 CR 3 North Elkhart, IN 46514 Al �SpUTH BF� d . MACE 1965 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS November 22, 2016 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Century Center Electrical Distribution Upgrades Project No. 116-007 Dear Mr. Carpenter: The Board of Public Works, at its meeting held on November 22, 2016, approved the Project Completion Affidavit for this project in the amount of $89,877.08. A copy of the Project Completion Affidavit is enclosed for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Linda M. Martin, Clerk Enclosure c: Rich Estes, Engineering Scott Herczeg, Century Center Toy Villa, Engineering GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME PROJECT NO. ., l —pa 7 FiNAECOSTdg9, B7'7.0$ CONTRACTSIGNED 3=/q-?O/.6 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION WITNESSETH: 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. Executed this __L1L_ day of Vlqj� k v✓ 20 1 � Signaturqe //�� Company Name Nail l'a+lY„�G+ SSlbq 6/ 3 A,4, Printed Name Company Address _ EIKA-A 71,% yGs/y City/State/Zip WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally appeared NJ ca4 e- Ca rpert+?' , and acknowledged his/her signature to the above Project Completion Affidavit on the �r} da of MovewiJoe✓,2016 Notary Signature My Commission Expires 4 c*-ie LSieve(S Printed Name County of Residence If the' Contractor is a corporation, the following certificate will be executed. I, NgP, +pe..k✓ , certify that I am Secretary of the Corporation executing this release; that WAh in -a k�✓ who signed this release on behalf of the contractor was then P�FD 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: k11� Secret ry's Si nahr. Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be . ordained so. C Date: I I 15 14 Construct' n anager BOARD OF PUBLIC WORKS APPROVAL Date: Gary A. Gr ot, President Suzanna )ff. Fritzber , Meni er James A. Mueller, Member Therese Elizabeth A. Maradik, Member M. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of C/khiq/ 4— SS: Qr,4, (mr� ✓ being duly sworn that he/she is the 0 (Nafne of Officer) (Title) of Z)'4��i Em/.a�ra having contracted with �'� Y� %o�/t 6 c 1,✓ r (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: C!r cam.., e / .�'e,,, n, W I. r _i T -Z for a project known as (Name located at -C s-' a%c and owned by /�/ao _Lr74, 0Ic �co_A 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 t4e sum of St o_c>-Wc j,4 cf ❑ 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, famished 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 material famished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. /I Dal (SO!?P-M ' By (Firm) (Autho ' d Representative) STATE OF INDIANA ) L 1 ekor+ ) SS: ST-d9SERH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared _Llod e C=Q r Pr I� 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 day of 20V !�A / ^-- I Notary Public Signature My Commission Expires: 4 - a 4 —0 b,4 \ / Residing in l✓ 1144, ri— county, � Vl GL{. P-LY�GL NotaryyPublic Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/15/16 Name Toy Villa Department Engineering BPW Date 11/22/16 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 I-1 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 Requ ❑ No ❑ Yes Name of Companv Distribution 116-007 Hotel -Motel Tax 7304.42010.0000.0099 $ 89,877.08 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc Amount of ❑ Increase $ ❑ Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Dispersal After Approval Copy Original ® ❑ Rich Estes ® ❑ Scott Herc; ® ❑ Toy Villa