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Home My WebLink AboutPCA - Lawn Care Services Project No 116-002 A,B, and C - Caretaker Landscape & Lawn1316 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 Kathleen Pritchard Caretaker Landscape & Lawn PO Box 324 Michigan City, IN 46360 RE: Project Completion Affidavit — Lawn Care Services Project No. 116-002A, B, and C Dear Ms. Pritchard: PHONE 574/235-9251 FAx 574/235-9171 The Board of Public Works, at its meeting held on December 13, 2016, approved the Project Completion Affidavits for the above projects in the amounts of a) Project No. I I6-002A (1) Final Contract Amount: $32,370 b) Project No. I I6-002B (1) Final Contract Amount: $69,090 c) Project No. 116-002C (1) Final Contract Amount: $2,280 A copy of the Project Completion Affidavits are enclosed for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerel , Linda . Martin, Clerk Enclosure c: Kevin Fink, Engineering Aaron Kobb, Community Investment Toy Villa, Engineering GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU u i"1 CITY OF SOUTH BEND, INDIANA °Y `; BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME PROJECT NO CONTRACT SIGNED 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 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. this day of 201 Le WITNESSESS: Before me, th undersigned Notary Public in and f, gix4Loe, Ve, 4�kk and acknowledged his/her ,the`,ae4 of day off /L ccy..a n kp.,i201sL .�A. Notary Si bture/ IP Printed Name Caretaker Landscape & Lawn Company Name P.O. Box 324 Company Address Michigan City IN 46360 City, State, Zip La Porte County My Commission Expires January 26, 2024 County of Residence La Po r 1 -e 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 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: Affidavit on Secretary's Signature Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This is acceptable r final approval and we recommend to the Board of Public Works that it be ordained so. Date: Constructi tanaggr Gary A. Gilot, President Therese J. Dorau, iMerritak BOAR OF PUBLIC WORKS APPRO' SuzannalM. Fritzberg,pember N Ja es A. Mueller, Member AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of � r , } tt S S: �Cocp.6Th being duly leer sworn that is the r �)4 IfrlLticr of I A (title) (Subcontractor/Supplier) having contracted with Lxekk lolykcqlaca (Contractor) �')�� to furnish certain materials and/or labor as follows: -- ---- for a project known as located at and owned by and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that er IsAJue from the Contractor the sum of Dollars 1 ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and F nal Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective undersigned; only upon receipt of payment thereof by the (FINAL WAIVER) that thefitpal balance due from the contractor is the sum of N ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Fiial 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 .md 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 material furnished to the undersigned for said project, am within the scope of this Affidavit and Waiver of Lien. lm By lXS1XJln_ STATE OF INDIANA ) (Authortzad Representative) cW-fh;R IE ) SS: �H COUNTY ) Before me, the undersigned, a Notary public, in and for said County and State, ersonall and acknowledged the execution of tine foregoing Affidavit and Waiver of Lien. p ed�h�_ IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed m fficial seal on e fit]✓P111 �o Q �•� 3O day of N ary c tgnature My Commission Expires:� " �i -�O 1'%`'`�'-;�w;=�-r,-�...,<^._:� _- _ y; w�a Residing in L1p e iM1 IB T BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/29/16 Name Toy Villa ' \v Department Engineering BPW Date 12/13//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 El 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 Intormation iker Landscaping & Lawn Yes � No MBE n WBE ❑ No ❑ Yes Name of Company Lawn Care Services 116-002A EDIT 408.1050.4E $ 32,370.00 ❑ 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 ® ❑ ® ❑ Kevin Fink Aaron Kobb Tov Villa uired For Change Orders Dispersal After Approval PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: Al eery, CITY OF SOUTH BEND, INDIANA %'� BOARD OF PUBLIC WORKS - PROJECT COMPLETION AFFIDAVIT 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. pp Executed this ft�t CKttCT day of ( 2Q Caretaker Landscape & Lawn —VOAA�tOQ,Y1 1\l f fir\ CM1 Company Name 'S,i/g�njattprret I P.O. Box 324 ) W)Y` \pSpe-r\ �s_1iy� J Company Address Printed Name Michigan City, IN, 46360 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and f ii�+4 1 Qr 1 • ram, and acknowledged his/her the or Q- day of 9C. U,e 201 r said country and state, personally appeared signature to the above Project Completion Affidavit on HOLLY M. KOLASA La Pate Canty My Commission Expi n Qgkq�6, 20 ) Cp- Printed Ndme County of Residence L.o Po r4 i If the Contractor is a corporation, the following certificate will be executed. 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 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. CX C Date: Construction; 9nager aaryA. Gilo, President Therese J. Dor u, Member BOARD F PUBLIC WORKS APPROVAL Date: A" -3 A uza na . F ' berg, Me er Elizabeth A. Maradik, Member Jam s A. Mueller, Member 1 da M. Martin, Cl k AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of (Name jof 0111cer) being duly sworn that he/she is the )1 i� � / y f"qN (_ of I (Trt)�e) tL,C 1 (Subcontractor/Supplier) having contracted with41 to famish certain materials and/or labor as follows: for a project known as located at and owned by (Contractor) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that terg is� ue from the Contractor the sum of /� Dollars (S ❑ 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 undersigned; only upon receipt ofpayment thereof by the (FINAL WAIVER) that th7fi al balance due from the contractor is the sum of A ❑ receipt of which is hereby acknowledged; or i ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shah become effective only upon receipt of such payment I 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 an ; and further certified that no other lien on account of any work performed or material furnished to the undersigned for said project, d withhin the sany claim or right to a cope off this Affidavit it and Waiver of Lien. (Firm) BY )�(nA :/1 U�d �^ pn /'lI/)4/7V St T�� OF I DIANA ) (Author ed Representative) , .10b HCOUNTY ) SS: Before me, the undersigned, a Notary Public, in and for said County and S and acknowledged the execution of the foregoing Affidavittate, personally appeared and Waiver of Lien. IIN�W;IT�.NE S WHEREOF, I have hereunto subscribed name and affixed in vial se!l on theme y f / day o Niy Commission Expires: _�1— �i / I Residingin L.,XArr— County, viy ��rnrd �'x+iras �U Ituowrtame Date Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM 11/29/16 Toy Villa Department Engineering BPW Date 12/13//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 Required Information & Lawn Yeses No MBE I1 WBE U No ❑ Yes Name of Company Lawn Care Services 116-002B EDIT 408.1050.460.39.89 ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) ired For Chanqe Orders Amount of L1 Increase $ ❑ Decrease $ Previous Amount $ Current Percent of Change: New Amount $ Total Percent of Change: % Dispersal After Copy Original ® ❑ Kevin Fink ® ❑ Aaron Kobb ® ❑ Toy Villa PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS ati, PROJECT COMPLETION AFFIDAVIT'' 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. Executed this � day of QcN em ke r , 201_ Caretaker Landscape & Lawn K-k6oba., PA jr�ozd Company Name iSignature P.O. Box 324 K in��ee 11e 1 d Company Address 'Printed -�Name Michigan City IN 46360 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said KcA L.wv` N'4�4r�l, and acknowledged his/her_ sionat the o�31L- day of NO t-) e *,6 -,, 201 (P �Iv1i /t Printed Name and state, personally appeared e above Project Completion Affidavit on HOLLY M. KOLASA La Pate County My Commission Expires z I&miccion LIMA 2024 L County of Residence L r- Po r, q -e 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 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 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: 11 • t L • L ruc Consttio Hager BOARD F PUBLIC WOf; CS APPROVAL Date: PO%C, Vary A. Gilot' President Sluzanna M. Pritzberg,'embe Elizabeth A. aradik, Member i Therese J. Dora , Member JamO A. Mueller, Member inda M. Martin, Jerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of 1 � PQ r 1(V SS: being duly sworn that he/she is the ly=t-3.�ti (Name of Officer) n p A (Title) of /J \II /J 11_. having contracted with (Subcontractor/Supplier) (Contractor)S `al' /� J to furnish certain materials and/or labor as follows: for a project known as located at and owned by and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that Ikerl is ue from the Contractor the sum of AJ1p1 t Dollars ki j A— ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and I'inal 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�fipall balance due from the contractor is the sum of !!VV (s ) A)A ❑ 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 otter party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, a+ wi and Waiver of Lien. thin the scope of this Affidavit CA 011114 JAM By I -� (F) STATE OF INDIANA (Authorized Representative) ) LFlPo ) SS: EP C EPx COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personal ehd and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WI S WHEREOF, I have hereunto subscribed my�n]am�e and �affixed official seal o the 3o day of (D V Q.� P F6 JW Signat My Commtsslon Expires: 9!�' 2 A a% (�, ,, a ry:� ` _er � County, ; l t zt.a l_o`t; ZA Residi m t�:�.tacuu,r; ..Gag"t ' ' ; cxpiras No ie Name Feislarp 3, i� 17 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/29/16 Name Toy Villa T Department Engineering BPW Date 12/13//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: Required Information Company or Vendor Name Caretaker Landscaping & Lawn New Vendor ❑ Yes N No ❑ If Yes Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Compan Project Name Lawn Care Services Project Number 116-002C Funding Source EDIT Account No. 408.1050.460.39.89 Amount $ 2,280.00 Terms of Contract Purpose/Description ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Required For Change Orders Only Amount of ❑ Increase $ ❑ Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Dispersal After Approval Copy Original ® ❑ Kevin Fink ® ❑ Aaron Kobb ® ❑ Toy Villa