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Home My WebLink AboutPCA - Leighton Plaza PArking Garage Vent Pan Replacement Proj No 116-091 - Slatile Roofing, 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 January 10, 2017 Gerald Longerot Slatile Roofing, Inc. 1703 S Ironwood Drive South Bend, IN 46613 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Leighton Plaza Parking Garage Vent Pan Replacement Project No. 116-091 Dear Mr. Longerot: 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 $12,500. 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, l Linda M. Martin, Clerk Enclosure c: Toy Villa, Engineering GARY A. GILOT SUZANNA M. FRrrZBERG ELIZABETH A. MARADIK JAMEs A. MUELLER THERESE J. DORAU PROJECT NAME PROJECT NO 116-091 CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Plaza Parkino Garage Vent Pan RenInvPment e CONTRACT SIGNED 9/27/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Replacing 3 Ceiling Vent Pans 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. 4Exe&cut this day �( t P , 201 0 Slatile Roofing and Sheet Metal Inc. uPU�qCompany Name R/,g+nature 4 `P,. C 1703 S. Ironwood Drive /.�� ' f L O Atl e r o� ��Qg/ D °f/ Eompany Address it ted Name = $EPA SDUth Bend, IN 46613 = Gity, State, Zip WITNESSESS: Before me the undersi ned Notary Public in and for said'sgyf�4�jt 6fd� t personally appeared , and acknowledged his/her signature fb'theoatiove Project Completion Affidavit on the y of e c 201 t o N tary Signature My Commission Expires Lou Ann Ward �.�„ Notary Public for the State Of IN a • Printed Name Count of Residence County of Residence- Elkhart Y Exolres 9/1/2021 If th Contractor is a corporation, the following certificate will be executed. I, Lz �a r certify that I am Secretary of the Corporation executing this release; that e.Q.Ap o who signed this release on behalf of the contractor was then SZof said Corporation; that said release was duly signed for and on behalf of said Cyfpration by Aupority of its goy@rning body, and is within the scope of corporate powers: Corporate Seal DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: 12 • t 3 14 Constructio nager Date: ti % //- /1/ 7 WA M. Martin, AFFIDAVIT AND WAIVER OF LIEN Star of Indiana, County of ter— SS. bJg J duly sworn that he/she is the �r CS 1 (Name of Offirfeli (Title) of S ( 6 Q Rz"=-4ni having contracted with (Subcontractor/Supplier) ' 1 n (Contractor) to furnish certain materials and/or labor as follows: U�� "rt„,-� for a project known as located at and owned by and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars ($ ) ❑ receipt of which is hereby acknowledged; or 211� 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 WAIV that the fipal/jfahan�ceco®{racto isyt/h�esum of I )� /L.l w .1t tip+ J/`iv'r ❑ 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 F,*99#nt of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed he�ef41+,jt�ny�d, er certified that no other party has any claim or right to a lien on account of any work performed or material furlusQ-to the under4ed for said project, and within the scope of this Affidavit and Waiver of Lien. (Firm) eb q ,t 7Authorfz e tepresentahve) STATE OF INDIANA ) �� SS. ST. JOSEPH COUNTY %� ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared h�'-24 CdJ Ley o� and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. INTNESS WHEREOF, I have hereunto subscribed r an off . 1 dal on the _ �� day of Lou Ann Ward No ry Public Signature Notary Public for the Stat of IW My Commission Expires: Countv of esklenoe- E k ✓ 1. Expires 9/1/2021 Residing in County, Notary Public Name 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 ❑ I Check the Appropriate Item Type — Required for Ail Submissions ❑ Agreement ❑ Contract ❑Pro osal ❑ Professional Services p ❑Addendum ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Re El Quote Opening ❑ Quote Award q to Advertise ❑Title Sheet ❑ 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 ❑ No ❑ Yes Name of Comoanv Pan 116-09 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment. E-Verifv. Iran_ etc Amount of Lj Increase ❑ Decrease Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Copy Original ❑ ❑ Ron O'Connor vma or Change Orders O Dispersal After