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Home My WebLink AboutPCA - Olive Road Lighting over the Indiana Toll Road Proj No 115-124 - Michiana Contracting, Inc.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BOTTIGIEG, MAYOR BOARD OF PUBLIC WORKS March 28, 2017 Scott Wallsmith Michiana Contracting, Inc. PO Box 929 Plymouth, IN 46563 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Olive Road Lighting over the Indiana Toll Road Project No. 115-124 Dear Mr. Wallsmith: The Board of Public Works, at its meeting held on March 28, 2017, approved the Project Completion Affidavit for this project in the amount of $32,211. 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 l Enclosure c: Toy Villa, Engineering GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMEs A. MUELLER THERESE J. DORAU ;o sourxp�o CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT ,.. PROJECT NAME Olive Lighting over the Indiana Toll Road PROJECT NO 115-124 FINAL COST $32,211.00 CONTRACT SIGNED 10/11/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Convert Olive Rd bridge liahtina to sinale phase power. 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 is 7th. day of 2017 Michiana Contracting, Inc. ti Company Name Signature P.O. Box 929 Scott Wallsmith Company Address Name Plymouth, IN 46563 City, State, Zip WITNESSETS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Scott Wallsmith ,and acknowledged his/her signature to the above Project Completion Affidavit on tl:e 7th ddayooff Mar2017 Signature My Commission Expires March 27, 2022 Andrea Jae Fisher Printed Name County of Residence Marshall If the Contractor is a corporation, the following certificate will be executed. Scott Wallsmith , certify that I am Secretary of the Corporation executing this release; that Scott Wallsmith who signed this release on behalf of the contractor was then President of said Corporation; that said release was duly signed for and on behalf of said Corporativh by Aut ityof its governdy, and is within the scope of corporate powers: r� Z, Secretary's Signature Scott Wallsmith Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable far final approval and we recommend to the Board of Public Works that it be ordained so: Date: 3 . I • 1 `l Constructio onager Gary A. Gilot, President BOARD OF PUBLIC WORKS APPROVAL Suzanne M. Fritzberg, Member Therese J. Dora i, Member James A. Mueller, Member Date: b/7 Elizabeth A. Maradik, Member M. Martin, State of Indiana, County of AFFIDAVIT AND WAIVER OF LIEN Marshall SS: Scott Wallsmith being duly sworn that lie/she is the President (Name of Officer) (Title) of Michiana Contracting having contracted with City of South Bend (Contractor) (Owner) to furnish certain materials and/or labor as follows: Lighting over Indiana Toll Road (Description) for a project known as Olive Lighting over Indiana Toll Road (Name of Project) located at Olive Street and owned by City of South Bend 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 ❑ 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 WAIVER) that the final balance due tiom the contractor is sum of Five Thousand Five Hundred Twenty —Three Dofirms ($5,523.7)4 nd Seventy —Four Cents ❑/ receipt of which is hereby acknowledged; or lw 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, subj act 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 aid project, and within the sco this Affidavit and Waiver of Lien. Michiana Contracting, -Inc.. By _ (Finn) (Authorized Representative) STATE OF INDIANA ) ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared _S c o tt Wallsmith and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my off�cial pal on the9t_ e h day of March 200 2017, otary Public i atm•e My Commission Expires: March27, 2022 A dreg J��OR�A�HSHEA I n d i aM4_ Marshall Notar Pu i • - =1ndiana l Residing in County, NotLPublie2 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 03/10/17 Department Public Works Toy Villa Division/Bureau Engineering BPW Date 03/28/17 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 ❑ 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: F Other: Company or Vendor Name New Vendor MBEANBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of Increase Previous Amount Current Percent of Change: New Amount Total Percent of Chanae: Copy Original ❑ ❑ ❑ ❑ ❑ ❑ uired Information Michiana Contracting, Inc. Yes M No It Yes, Approved by ❑ No ❑ Yes Name of Company Olive Road Lighting over the Indiana Toll Road 115-124 COIT 404.0602.431.31.06 $32,211.00 Proiect Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc. For Chanae Orders After Approval