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Home My WebLink AboutPCA - Fire Station #7 HVAC - Ideal Consolidated, Inc.1316 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 Fred Mohler Ideal Consolidated, Inc. 806 W Sample St. South Bend, IN 46601 RE: Project Completion Affidavit — Fire Station No. 7 HVAC Project No. 116-067 Dear Mr. Mohler: PHONE 574/235-9251 FAX 574/235-9171 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 $11,760.00. 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, I Linda M. Martin, Clerk Enclosure c: Toy Villa, Engineering Kevin Fink, Engineering GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU `asou ru 8.ry. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT , INO PROJECT NAME Fire Station #7 HVAC PROJECT NO 116-067 FINAL COST $11,760.00 CONTRACT SIGNED 8/30/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Install a Ductless Single Zone Hear Pump in Fire Station #7, 1616 Portaqe Ave. 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 c 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. Execut this 4th day of November 2016 Ideal Consolidated, Inc. 77;� j�a/l„�— Company Name Signature 806 W. Sample St. Fred Mohler Company Address Printed Name South Bend, IN 46601 City, State, Zip WITNESSETS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Fred Mohler and acknowledged his/her signature to the above Project Completion Affidavit on the 4th day of November 201 6 "h �nE�mmission Expires JosepCount nisslon # 654785 08/01/22 of Residence St. Joseph If the Contractor is a corporation, the following certificate will be executed. Jennifer M. Brown certify that I am Secretary of the Corporation executing this release; that Fred Mohler who signed this release on behalf of the contractor was then Service Manager of said Corporation; that said release was duly signed for and on behalf of said Co poration by uthority of its governing body, and is within the scope of corporate powers: S car tas Signatll/V ture Corporate Seal 5ennifer M. Brown Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptablefo final approval and we recommend to the Board of Public Works that it be ordained so. I Date: l l - l 14 Constructio anager BOAR OF PUBLIC WORP APPROVAL Date: // Gary A. Gil President S zanna . Fritzberg, 6 ember , Elizabeth A Maradik, Member Therese J. Dor u, Member James A. Mueller, Member ¢ a M. Martin, Clerk Project 116-067 0 Final AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of St. Joseph, SS: ❑ Partial ❑x Payment to Follow Jennifer M. Brown being duly sworn states the she is the Corporate Secretary of Ideal Consolidated, Inc., having contracted with City of South Bend. to furnish certain materials and/or labor as follows: HVAC Work for a project known as Fire Station #7 HVAC, located at South Bend, IN and owned by the City of South Bend and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the contractor the sum of: Dollars ($.00) ( ) receipt of which is hereby acknowledged; or ( ) the payment of which has been promised as the sole consideration of this Affidavit and Partial 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: Eleven Thousand Seven Hundred Sixty Dollars ($11,760 00) () receipt of which is hereby acknowledged; or (X) the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien, which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above -described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Idea! Consolidated, Inc. Corporate Secretary By Title: Firm Aluth rizedRepresentative Jlgnyifer M. Brown WITNESS MY HAND AND NOTARIAL SEAL, this 4th day of November 2016. My commission expires: 08/01/22 Residing in St. Joseph County � &a Notarjl Public Printed: Mary A. LaPlace ... ... ... MARYA. LAPLACE `moinnr'• :Notary Public, state of Indiana St. Joseph County sEni : g Commission # 654785 MY Commission Ezpires "a„.n "' August 01, 2022 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/10/16 Name Toy Villa J 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 ❑ 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 Ideal Consolidated ❑ Yes Z No ❑ If Yes MBE ❑ WBE ❑ No ❑ Yes Name of Company Fire Station #7 HVAC 116-067 Uapital Improvements 11, 760.00 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Change Orders Only Increase Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ® ❑ ❑ ❑ Toy Villa Kevin Fink Atter Approval