HomeMy WebLinkAboutPCA - 2016 Curb and Sidewalk Construction Proj No 116-029 - Premium Concrete1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1830
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
January 10, 2017
Becky Yeaky
Premium Concrete
712 Richmond St.
Elkhart, IN 46516
RE: Project Completion Affidavit — 2016 Curb and Sidewalk Construction —
Project No. 116-029
PHONE 574/235-9251
FAX 574/235-9171
Dear Ms. Yeaky:
The Board of Public Works, at its meeting held on January 10, 2017, approved the Project
Completion Affidavit for this project in the amount of $404,298.70.
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,
J
Linda M. Martin, Clerk
Enclosure
c: Toy Villa, Engineering
GARY A. GHAT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU
PROJECT NAME
PROJECT NO
CONTRACT SIGNED
PROJECT DESCRIPTION
WITNESSETH:
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
e
PROJECT COMPLETION AFFIDAVIT
b and Sidewalk Construction
116-029 FINAL COST $404,298.70
of new curb and
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.
WITNESSES:
13efore me, If
the ojv day of
201 Premium Concrete
Company Name
712 Richmond St
Company Address
Elkhart, IN 46516
City, State, Zip
ad Notary Public in and for said county and state, personally appeared ifAXY'r• 7L0.KEy 44
and acknowledged hiCompletion Affidavit on
Notary Signaturk w I \`
Gti� ( J. l ay%s .__
Printed Name
^�Eo CHERYL J TAYLOR
Notary Public, State of Indana
- Elkhart County
Commission N 61663ii
M y, Commission Expire_
omrr teJM ExRir'MI 8
03 �17�a O /d
( O
County of Residence
If the Contractor is a corporation, the following certificate will be executed.
I, 04a v A Vd certify that I am Secretary of the Corporation executing this release; that
who signed this release on behalf of the contractor was then
[ den of said Corporation; that said release was duly signed for and on behalf of said
Corporation byhgfhority of its governing body, and is within the scope of corporate powers:
Secretary's Signature Corporate Seal
Mau A Ye 60Lkcs
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable or al approval and we recommend to the Board of Public Works that it be ordained so.
Date:
Construct n- tanager
BOARD OF PUBLIC WORKS APPROVAL Date:
Gary A. Gil resident uza na erg, M ber Elizabeth A Maradik, Member
n
Y. b%iL-o-
Therese J. Do(,au, Wmber James A. Mueller, Member A,i da M. Martin, Clerk
*
*
*
MAINTENANCE BOND
Bond No2156811
KNOW ALL MEN BY THESE PRESENTS:
That, Premium Concrete Services, Inc., 712 Richmond St, Elkhart, IN 46516
as Principal,
and Old Republic Insurance Company a corporation organized under
the laws of the State of Wisconsin and authorized to do a surety business in
the State of Indiana , as Surety, are held and firmly bound
unto the City of South Bend, Indiana, Department of Public Works , as obligee
in the sum Of Forty Thousand Four Hundred Twenty-nine And 87/100THS
($40,429.87 ), lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind
ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents:
SEALED with our seals and dated this 21 st day of December , ,2016
WHEREAS, on the 26th day of April , 2016 , the said principal as contractor, entered into a contract for:
2016 Curb and Sidewalk Construction; Project No. 116-029
for the sum of Three Hundred Fifty-nine Thousand Seven Hundred Fifty And No/100THS
($359,750.00 I; and,
WHEREAS, under the terms of the specifications for said work, the said principal is required to give a bond in the amount of Forty
Thousand Four Hundred Twenty-nine And 87/100THS ($_40 429 87 ), to protect the
obligee against the result of faulty materials or workmanship for a neriod ofThree /3vear(s) from and after the date of the completion and
acceptance of same, namely, until .I220/2019
Now, THEREFORE, if the said principal shall for a period ofThree (3year from and after the date of the completion and acceptance of same
by said obligee replace any and all defects arising in said work whether resulting from defective materials or defective workmanship, then
the above obligation to be void; otherwise to remain in full force and effect.
Old Republic Insurance Company
;Surety
By
II r
Nicole L. Bicknell Anomey-m-Fact
case 22518 (1 93)
* OLD REPUBLIC INSURANCE COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY,a Pennsylvania stock iduranbe corporation, does
make, constituteand appoint:
NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, DEBRA K HULL, BARBARA E PEARSON, JENNIFER L KASZNIA-SANDRA L JUNK,
_ - WILLIAM J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEMER, OF SOUTH BEND,iN -
-__- its true and lawful Attomey(s)-in-Fact, with full power -and authority, not exceeding.$50,000,000, for and on behalf of the Company as surety, to execute
- = and deliver and affix the -seal of the Company thereto -(if a seal is required), bonds, undertakings, recognizances or other written obligations in -the nature
thereof, (other than self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste manage-
ment bonds, hazardous waste remedia_tion bonds or black lung bonds), as follows:
ALL WRITTEN INSTRUMENTS INANAMOUNT NOT TO EXCEED AN AGGREGATE OF
FOURMILLIONDOLLAR6 ($4,000, 000)---------------------- FOR ANY SINGLE -- _
OBLIGATION, REGARDLESS OF THE NUMBER OF INSTRUMENTS ISSUED FOR THE OBLIGATION.
_ and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and
confirmed. This documentisnot valid unless printed on colored background and is multi -colored. This appointment is made under and by authority of
- _ the board of directors at a meeting held on March 14, 2014. This Power of Attorney is signed and sealed by facsimile under and by the authority of the
- _ - following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on March-14, 2014.
RESOLVED FURTHER, that the chairman, president or any vim president of the Company's surety division, in conjunction with the secretary or
any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of
- the Company may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such --
persons to -execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship otil_igations of all kends -_
otherihan_bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of mstaArneopaper and note
guaranty_ bonds. The said officers may revoke any Power of Attorney previously granted to any such person. The authorityof any Power of = _=
Attorney granted by any such officer of the Company as aforesaid shall not exceed fifty million dollars ($50,000,000.00), exdept (ajbonds
required to be filed as open penalty bonds, and (b) bonds filed with any court or governmental authority requiring an unlimited -penalty in__bonds
- filed in that court.
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
;(1) when signed by the chairman, president or any vice president of the Company's surety division and attested and -sealed (if a seal be �,
required) by any secretary or assistant secretary; or - -
(ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of they Company (if a seal be required)
RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any
Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, orother suretyship
obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by Its proper officer, and its
_-- corporate seal to be affixed this 24TH day of AUGUST, 2015.
OLD REPUBLIC INSURANCE COMPANY
`� psue,yWa
Ass snt Secretary�—
STATE OF WISCONSIN, COUNTY OF WAUKESHA- SS r Vice President On this 24TH. day of AUGUST, 2015., personally came before me, :ALAN PAVLIC and
- PHYLLIS M%JOHN ON to me known to be the Individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who
executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that
they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate
seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said -
organrcation -
_ p0TA9i s -
Notary Public
- - My commission expires: 9 / 2 B / 18
CERTIFICATE -(Expiration of notary corrimiasion does not Invalidate this Instrument)
I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing
and attached Power of Attorney remains in full force and has not been revoked; and furthermore,_ that the Resolutions of the board of directors set forth in
the Power of Attorney, are now in force.
45-5314 f T4 f /
Signed and sealed at the City of Brookfield, WI this L -, day of_--
- �e
e W t SEAL °
0 _
GIBSON TNRRRANr`R Ar] .11 1.1 - - Asslsld t R2Wry
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BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 01/03/17
Name Toy Villa Department Engineering
BPW Date 01/10/17 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 ❑
❑ Agreement ❑ Contract ❑ Proposal ❑Addendum
❑ Professional Services ❑ Resolution
❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet
❑ Quote Opening ❑ Quote Award
❑ Change Order No. 5 ❑ 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
Kequired Information
Premium Concrete
El Yes ®No ❑ If Yes. ADDroved by Purchasina
❑ No LJ Yes Name of Company
2016 Curb and Sidewalk
116-029
MVH
9.431.31.06
404,298.70
Project Closeout
❑ Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination. Non -Debarment_ F-Verifv Iran Pt(
Increase
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Change:
Copy
Original
®
❑
Terri Swift
Villa
For Chance Orders
Dispersal After