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HomeMy WebLinkAboutPCA - Martin Luther King Jr Center HVAC Revisions Proj No 116-064 - Hermann & Goetz Inc.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 4660I-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS February 14, 2017 Larry Cripe Hermann & Goetz, Inc. 225 S Lafayette Blvd. South Bend, IN 46601 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Martin Luther King Jr. Center HVAC Revisions Project No. 116-064 Dear Mr. Cripe: The Board of Public Works, at its meeting held on February 14, 2017, approved the Project Completion Affidavit for this project in the amount of $379,708. 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: Toy Villa, Engineering Aaron Perri, Parks & Recreation John Martinez, Parks & Recreation GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECTNAME Martin Luther King Jr. Center HVAC Revisions PROJECT NO. 116PO64 FINAL COST $379,708.00 CONTRACT SIGNED MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION HVAC Revisions 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. Execute tl's of January 20 17 Herrman & Gnet7, Tnr_ gnr Company Name trry Cripe 225 S. Lafayette $lvd. Printed Name Company Address Smith Band, TN 46601 City/State/Zip WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally appeared Larry Cripe , and acknowledged his/her signature to the above Project Completion Affidavit on the 16th day of January , 2017 Notary Signatu a My Commission Expires 7/13/2022 Catherine J. Gnuber Printed Name County of Residence St. Joseph If the Contractor is a corporation, the following certificate will be executed. 1, Ka ht een A. Herrman, certify that I am Secretary of the Corporation executing this release; that Larry Cripe who signed this release on behalf of the contractor was then Power —of —Attorney of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secre A SL re Corporate Seal Kathleen A. Herrman Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: Z • l 4 • l "1 Construc of Manager BO RD OF P> BI,I6'ROVAL Date Gary A. Gilo , President Suzanna M. Fritzberg, Member Jam A. Mueller, Member Therese J. D rau, Member Elizabeth A.,Maar/adik,,�Member i �st:. Y G( /"Y( da M. Martin, Clerk MAINTENANCE BOND Bond No. 929635363 KNOW ALL MEN BY THESE PRESENTS: Herrman & Goetz, Inc. That 225 S. Lafavette Blvd South Bend. IN 466 as Principal, hereinafter called Contractor, and Continental Casualty Company 8900 Keystone cross np Suit . 1180 Indinnnnn is IN 46240 , as Surety, hereinafter called Surety, are held and firmly bound unto City of south Bend 227 W Jefferson South Bend IN 46601 __ , as Obligce, hereinafter called Owner, in the penal sum of Thirty Seven Thousand Nine Hundred Seventy One Dollars and 00/100 Dollars ($ 37 971 00 ), for payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. WIIEREAS, Contractor has constructed various public improvements: Martin Luther King Jr Center HVAC Revisions Project 116-064 in accordance with the General Conditions, the Drawings and Specifications, which Plans are by reference incorporated herein, and made a part hereof, and is referred to as the Plans. NOW, THEREFORE, the condition of this obligation is such that, if Contractor shall remedy any defects due to faulty materials or workmanship, and pay for any damage to other work resulting therefrom, which shall appear within a period of Three (3) years from the date of substantial completion of the work provided for in the Plans, then this obligation to be void; otherwise to remain in full force and effect. PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable promptness. SIGNED and scaled this 16th day of January ,2017 In the presence of., Herrman & Goetz, Inc. B ThPrincipal (Seal) errma residue Title GASU", AfroorIvContinental C sualty Company o:44rrr C41 Surety By: Surety Phone No. 800-229-8396 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Tracie House , Individually of South Bend, IN their true and lawful Attomey-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature SuretyBond No:929635363 -InUnlimitedAmounts- Principal: Herrman & Goetz, Inc. Obligee: City of South Bend and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 1st day of December, 2015. �cASt1,�tTY � \NSUR.I fiC ANY u< F epRRORATp a' Yet.ORPBagT�o $ Z a IDLY it. oU SEAL = t tsoz 1 as 7 HARt4 • " Continental Casualty Company National Fire Insurance Company of Hartford American Ca lty Company of Re ding, Pennsylvania Paul T. Bmflat)Ace President State of South Dakota, County of Minnehaha, ss: On this 1st day of December, 2015, before me personally came Paul T. Bmflat to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. J.MOHR fuurtai+wem�i.� My Commission Expires June 23, 2021 J. Mohr Notary Public CERTIFICATE I, D. Bull, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 16th day of January, 2017. �PyeAsut<Tj 01NSUR�tCvAMYoe eoPPORATe JULn YHeGPY 11, 0 �t Z � RJ SEAL 'r � e tsar 1897 HART* • Continental Casualty Company National Fire Insurance Company of Hartford American Casualty ny Caassualty Company of Reading, Pennsylvania �� l .. A 4-- D. Bull — Assistant Secretary Form F6853-4/2012 Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duty adopted by the Board of Directors of the Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 251h day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")m execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of National Fire Insurance Company of Hartford. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bmflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of American Casualty Company of Reading, Pennsylvania. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25r' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " WRA1T Document G706ATM -1994 Contractor's Affidavit of Release of Liens PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: 116-064 OWNER ❑ Martin Luther Ring Jr. Center CONTRACT FOR: HVAC Revisions ARCHITECT ❑ CONTRACTOR ❑ TO OWNER: (Name and address) CONTRACT DATED: September 13, 2016 SURETY ❑ City of South Bend 227 W/ tIefferson Blvd. South Bend, IN 46601 STATE OF: Indiana OTHER ❑ COUNTY OF:St. Joseph The undersigned hereby certifies that to the best of the undersigned's knowledge, information and belief, except as listed below, the Releases or Waivers of Lien attached hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work, labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner arising in any manner out of the performance of the Contact referenced above. EXCEPTIONS: NONE SUPPORTING DOCUMENTS ATTACHED HERETO: 1. Contractor's Release or Waiver of Liens, conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. CONTRACTOR: (Name and address) Herrman & Goetz Inc. 225 S. Lafayette Blvd. South Bend, 46601 BY: (,5fgnat'761audjorrzed representative) Larry Cripe, Power—of^Attorney (Printed name and title) Subscribed and sworn to before me on this date: January 16, 2017 /j 1 Notary Public: �` SL/+u/"'-- 11 Catherine . GruberU My Commission Expires: 7/13/2022 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G706ATe —1994. Copyright ®1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document Is protected by U.S. Copyright Lew and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of It, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@ala.org. CONSENT OF SURETY OWNER ❑ TP FINAL PAYMENT ARCHITECT 0 CONTRACTOR 0 ,AIA Document G707 SURETY )0 Bond No. 929635363 OTHER C7 TO OWNER: ARCHITECT'S PROJECT NO.: 116-064 (Nmaaturdaddmwl City of South Bend 227 W Jefferson CONTRACT FOR: MLK Center HVAC South Bend, IN 46601 PROJECT. CONTRACTDATEDt September 13, 2016 (Nitmeand add=J Martin Luther King Jr Center HVAC Revisions Project 116-064 In accordance with the provisions of the Contract between die Ownerand the Contractor as Indicated above, the (Jamnnameand add)mofTumt i Continental Casualty Company 8900 Keystone Crossing, Suite 1 180 Indianapolis, IN 46240 on bond of (linen name and addrowgfCotnrwctar) i_ Yi179iit'� Herrman & Goetz, Inc. 225 S. Lafayette Blvd. South Bend, IN 46601 CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (laavrt trutuetmd adttnzw ofowue' City of South Bend 227 W Jefferson South Bend, IN 46601 as set forth in said Surety's bond. OWNER, IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date; January 16, 2017 gawp fntniliq tfk [nand follauwd 6rtlz armrcaicdatemrdJ¢var:l .Attest: (Seal): t CtlttR4gAPE 0 SEAL �1897� Continental (S1ntN19 / Tracie House Attorney -in -Fact (P) tt nett aam a and title) Surety Phone No. 800-229-8396 0707-1994 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Tracie House , Individually of South Bend, IN their true and lawful Attomey-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature SuretyBond No: 929635363 - In Unlimited Amounts - Principal: Herrman & Goetz, Inc. Obligee: City of South Bend and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this tat day of December, 2015. o �,yC.ANY0 ,NeeNPRRarrpya' JULY rl, � NAarF� • aR�r� Continental Casualty Company National Fire Insurance Company of Hartford American Ca by Company of Re ding, Pennsylvania �i Paul T. Bruflat ice President State of South Dakota, County of Minnehaha, ss: On this I st day of December, 2015, before me personally came Paul T. Bruflat to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seats of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. rm'nw OH MSOUIIIGNbfA My Commission Expires June 23, 2021 J. Mohr v Notary Public CERTIFICATE I, D. Bull, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 16th day of January, 2017. �01 GASUA0P i t11SUR4,yc _,[AANY0 Y cApvoMTP 5p g'� �NG4RPRRar�� P0 SEAL + tuisoi �. 1697 � HANrF� r • Continental Casualty Company National Fire Insurance Company of Hartford American Casualty Company of Reading, Pennsylvania ? V`)l .. A 4-- D. Bull — Assistant Secretary Form F6853.4/2012 Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Brufiat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25° day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Brufiat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of National Fire Insurance Company of Hartford. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25ib day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bmflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of American Casualty Company of Reading, Pennsylvania. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic fonust (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " AIA Document G706TM -1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: 116-064 OWNER ❑ Martin Luther King Jr. Center CONTRACT FOR: HVAC Revisions ❑ ARCHITECT CONTRACTOR ❑ TO OWNER: (Name and address) CONTRACT DATED: September 15, 2016 SURETY ❑ City of South Bend 227 W. Jefferson B1vdrJ. OTHER ❑ South Bend, IN 46601 STATE OF: Indiana COUNTYOF:St. Joseph The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. EXCEPTIONS: NONE SUPPORTING DOCUMENTS ATTACHED HERETO: 1. Consent of Surety to Final Payment. Whenever Surety is involved, Consent of Surety is required. AIA Document G707, Consent of Surety, may be used for this purpose. Indicate Attachment ❑Yes ❑No The following supporting documents should be attached hereto if required by the Owner. 1. Contractor's Release or Waiver of Liens, conditional upon receipt of final payment 2. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. 3. Contractor's Affidavit of Release of Liens CONTRACTOR: (Name and address) Herrman & Goetz, Inc. 225 S. Lafayette Blvd. South Bend, IN 46601 BY�(S , nation of autho ' ed representative) Larry Cripe, Power -of -Attorney (Printed name and title) Subscribed and sworn to before me on this date: January 16, 2017 Notary Public; g ), - CatherineJ. My Commission Expires: (AIA Document G706A). 7 / 13 / 2022 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G7067a —1994. CopyrightO 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This Al e Document Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of It, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e- mail The American Institute of Architects' legal counsel, copyright@aia.org. BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date January 31, 2017 Department Public Works Name Toy Villa � , Division/Bureau Engineering BPW Date February 14, 2017 Phone Extension 5920 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 ❑ George King 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 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 Herrman & Goetz, Inc. ❑ Yes ® No ❑ If Yes, Approved by Purchasing? ❑ MBE ❑ WBE ❑ No ❑ Yes Name of Company Martin Luther King Jr. Center HVAC Revisions 116-064 Parks Bond Improvement Allocation Fund $379,708.00 Renovation and Replacement of HVAC units and equipment Project Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Reauired For Chanae Orders Only Increase Decrease Previous Amount Current Percent of Change New Amount Total Percent of Chanae: Copy Original ® ❑ ® ❑ ❑ ❑ Aaron Perri — Parks & Recreation John Martinez — Parks & Recreation