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Home My WebLink AboutPCA - Century Center North Bridge LED Lamp Retrofit Proj No 116-007A - Days Corporation1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS December 13, 2016 William Halt Days Corporation 55169 County Road 3 Elkhart, IN 46514 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Century Center North Bridge LED Lamp Retrofit Project No. 116-007A Dear Mr. Halt: The Board of Public Works, at its meeting held on December 13, 2016, approved the Project Completion Affidavit for this project in the amount of $4,653. 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, CxC�, '—'yK_ —Y�aj� Linda M. Martin, Clerk Enclosure c: Toy Villa, Engineering Rich Estes, Engineering Scott Herczeg, Century Center GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU I o4� r�eF> CITY OF SOUTH BEND, INDIANA o, BOARD OF PUBLIC WORKS`''' PROJECT COMPLETION AFFIDAVIT PROJECT NAME Century Center North Bridge LED Lamp Retrofit PROJECT NO. 116-007A FINAL COST $4,653.00 CONTRACTSIGNED 1o/11/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Repair and Install LED lamps, Gaskets and needed mounting hardware. WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Executed this 21st day of November 120 16 f�gJ^ Days Corporation SigtatIu'r^e Company Name IA' Lt, L I Av`^ O Fi 1-- a 55169 Co. Rd. 3 Printed Name Company Address Elkhart, IN. 46514 City/State/Zip WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally appeared ttiJrv�, �V�+ and acknowledged his/her signature to the above Project Completion Affidavit on the day of bJew,,b(,v' , 201L. —No ary Signature My Commission Expires 4 -DA -aLoa � I I'dC e. L S i e v e ors Printed Name County of Residence E k h[g Y + If the Contractor is a corporation, the following certificate will be executed. I, certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then ofsaid Corporation: that said release was duly signed for and on behalf ofsaid Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: l 29 • l 4 Constrr� ucc`ts"anager BOA— F PUBLIC WOR S APPROV L Date: v�L• Gary A. Gi t, President Suzanna . r , Fritzbee ber Elizabeth A. Maradik, Member n _ ., A. Mueller, Member Therese J. Dor$ti, Metftber \l i 0a M. Martin, AFFIDAVIT AND WAIVER OF LIEN State olfIndiana, County of Elkhart SS: A e, (} being duly sworn that he/she is the V t e_- (Name of Officer) (Title) Of Days Corporation having contracted with City of South Bend, Indiana (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: Lamps, Gaskets, Mounting Hardware, and Labor (Description) for a project known as Century Center North Bridge LED Lamp Retrofit •(Name of Project) located at 120 S. St. Joseph St. South Bend, Indiana 46601 and owned by The City of South Bend (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 Four Thousand Six Hundred Fifty Three Dollars --------- 00/100 ($ 4,603.00 ) ❑ 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 Hen on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. Days Corporation By (Firm) (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 W Yn and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN SS WFIEREOF, I Have hereunto subscribed my name and affixed my offs ial seal on the day of 0\1r �e r 20Jd ( � �t Lk C-L �� LLuVa, Notary Public Signature My Commission Expires: 4 — a-4 Residing in E I "U l"+ County,ta t C IG i L S 1 C J e t S IYl(,11Ct-VIG Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/29/1 Name To_ Villa a Department Engineering BPW Date 12/13/16 Phone Extension 5920 uired Prior to Submittal to Legal L] 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 Professional Services ❑ Contract ❑Proposal ❑ Addendum ❑ Resolution ❑ El Bid Opening Quote Opening ❑ Bid Award ❑ Req. to Advertise ❑ Quote Award ❑Title Sheet ❑ Change Order No. ❑ C/O & PCA No. ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control n 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 red Inform U No ❑ Yes Name of Company Century Center North Bridae LED Lamn Ratrnfit 11 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Increase Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ Rich Estes Tov Villa ange Orders Dispersal After Approval