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Home My WebLink AboutPCA - Zimmerman Industrial Piping - North Station Filtration Plant Vessel #5 Raw Water Stainless Steel Pipe Replacement1316 COUN IY-CnY BUILDING 227 W. JEFFERSON BoULF,vARD Sot) I H BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS December 22, 2016 Robert Kelsey Zimmerman Industrial Piping 1117 Clay Street Mishawaka, IN 46545 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — North Station Filtration Plant Vessel #5 Raw Water Stainless Steel Pipe Replacement Dear Mr. Kelsey: The Board of Public Works, at its meeting held on December 22, 2016, approved the Project Completion Affidavit for this project in the amount of $31,885.50. 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: Matthew Bussell, Water Works Kim Thompson, Environmental Services GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMEs A. MUELLER THERESE J. DORAU C� CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME North Station Filtration Plant Vessel #5 Raw Water SS Pipe Replacement PROJECT NO. n/a FINAL $31,885.50 COST CONTRACT 07/12/2016 MAINTENANCE AGREEMENT n/a SIGNED ENDS PROJECT Demolition and Replacement of Water Treatment Process Piping 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 thisftday of /�L' 20�. Zimmerman Industrial Piping Signature Company Name /ZGy3LiZ%i®� /CE�ZSe-Ir 1117 Clay Street Printed Name Company Address Mishawaka, Indiana 46545 City/State/Zip WITNESS � o me, the u dersigned Notary Public in and for said country and state, personally appeared and acknowledged his/her signature to the above Project Completion Affidavit on the At 2. day of Oec e r•vtey, 2016 Notary Signah •e j My Commission Expires 1/1,7/.70 a 1�� U P y-1 v ,/ �i2 wo, it Cb / Printed Name County of Residence '10 N yy If the Contractor is a corporation, the following certificate will be executed. I, IZ&13L'➢Zi%E' lee See certify that I am Secretary of the Corporation executing this release; that /Zta3L'2�3" le?-ZSZ-41 who signed this release on behalf of the contractor was then /�/LESI �Je/vT` of said Corporation; that said release was duly signed for and on behalf of said Corporation nbbyyAuthority of its governing body, and is within the scope of corporate powers: �J -� 4G Secretary's Signature 126 /367v„ I, /Ge6n el-v Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This pr ject i acceptable for roval and we recommend to the Board of Public Works that it be ore ed s , ate: Construction Managerth BOARD OF PUBLIC W RKS APPROVAL Date: /�2-/.,9- 1 /L Gary A. Gilot, President Suzanna M. Fritzberg, Member -071—� Jarp es A. Mueller, Member Elizabeth A. Maradik, Member Therese J. orau, Member h Print Form CONTRACTOR'S FINAL RELEASE AND WAIVER OF LIEN Proiect/Owner GW Contractor g7V'T70/✓ f'/C1iao��—J3 Project:ye-5skz 0 5- t,&514.- eafllz- . 411F- Name: CnmwilA✓ Address: 830 Michigan Street South Bend. IN 46601 City State Zip Code Owner: South Bend Water Works TO ALL WHOM IT MAY CONCERN: Address: 11/-7 sz cell r 97- 1971113Wl,tW4a IA., Ve4;_ _K_ City state Zip Code Contractor Licence: Pe Pk601307 Contract Date: 07 l 12l _206 For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned Contractor hereby waives, discharges, and releases any and all liens, claims, and rights to liens against the above -mentioned project, and any and all other property owned by or the title to which is in the name of the above -referenced Owner and against any and all funds of the Owner appropriated or available for the construction of said project, and any and all warrants drawn upon or issued against any such funds or monies, which the undersigned Contractor may have or may hereafter acquire or possess as a result of the furnishing of labor, materials, and/or equipment, and the performance of Work by the Contractor on or in connection with said project, whether under and pursuant to the above -mentioned contract between the Contractor and the Owner pertaining to said project or otherwise, and which said liens, claims or rights of lien may arise and exist. The undersigned further hereby acknowledges that the sum of 0 rv6&" 7 ,.t 676-& "i' Dollars ($ / fl'16 < 52 constitutes the entire unpaid balance due the undersigned in connection wi h said project whether under said contract or otherwise and that the payment of said sum to the Contractor will constitute payment in full and will fully satisfy any and all liens, claims, and demands which the Contractor may have or assert against the Owner in connection with said contract or project. Witness to Signature: Dated this � day of �%` 20 {6 Contractors/ By: /�G Title: Page 1 of 1 G' P7�i Date Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM 12/13/16 Bussell. Matthew Department Utilities/Water Works BPW Date 12/22/16 Phone Extension 5670 Legal ❑ Attorney Name Michael Schmidt 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 ❑ ❑ 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: RequiredInformation Company or Vendor Name Zimmerman Industrial Piping New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company North Station Filtration Plant Vessel #5 Raw Water SS pipe Project Name replacement Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of Previous Amount Water Works Operating Fund 620.0640.602.36.05(Labor) 620.0640.604.23.10(Materials) $ Labor $9,208.00, Materials $22,677.50, Total $31,885.50 Replacement of Stainless Steel Piping that is leaking. ❑ Required Contractor's Certification Form Attached (Non - Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc. Increase Decrease Current Percent of Change: New Amount Total Percent of Change: Dispersal After Approval Copy Original ® ❑ Matthew Bussell ® ❑ Kim Thompson ❑ ❑