HomeMy WebLinkAboutProject Completion Affidavit - 2017 Tree Plantings Proj No 117-009B - Fuerbringer Landscaping & Design, Inc1316 Cotwry-Crry Bwu)w-,
227 W. JEFFf',RSON Bow,EVARD
Sourti BEND. INDIANA 46601-1830
CITY OF SOUTH BEND PETE BUTFIGIEG, MAYOR
BOARD OF PUBLIC W
December 12,2017
Dan Fuerbringer
Fuerbringer Landscaping & Design, Inc.
22530 Brick Road
South Bend, fN 46628
Pr OM,' 574/235-9251
FAX 574/ 235-9171
RE: Project Completion Affidavit — 2017 'Free Plantings - Project No. 117-009B
Dear Mr. Fuerbringer:
The Board of Public Works, at its meeting held on December 12, 2017, approved the Project
Completion Affidavit for this project in the amount of $19,000.
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
GARY A. Git,m, SLJZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A, MUELLER THERESE J. DoRAU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC 'WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME 2017 Tree Plantings
PROJECT NO 117-009B FINIAL COST $a19,000.00
CONTRACT SIGNED 9/1212017 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Plant'inq of various trees throughout curb & sidewalk project areas,
7i►KALIIZ&9l*M:
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 Contract.
Exehi's South Bend which were a Q�()1 a 6rt the ahoy ,%01 �� Fuerlaringer Landscaping & Design, Inc.
�� Company Name
Signature 22530 Brick Road
� (ZARZ 40-Company Address
Printed Name South Bend, IN 46628
City, State, Zip
WITNESSES&
Before me, the undersigned Notary Public in and for said count
ry and state, ersonall appeared
d ,! - a 4,2�?,r�,[s , and acknowledged his/her � t %8' 9' � �, r Ietion Affidavit on
the da rib �Y ALIC C, Nd kIfdLE`�
yof !,-,A, 201 7 . x INdIRNA
�~ NO�TNJO8EF"li COUNTY
�u ,, x i�res 9126f2p24 is
,r.
Notary Signature
Printed Name County of Residence
If the C tEpp
ion, the following cerkificute will be executed.
I, ""Cr.�t 1�2 _„ certify that I amSecretary of the Corporation executing this release; that
411
j who signed this release on behalf of the contractor was then
_ of said Corporation; that said release was duly signed for and on behalf of said
Cor oratiots governiing body, and is within the scope of corporate powers:
Secret ry's Signature
� f � Corporate Seal
Printed ame �t
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for h approval and we recommend to the Board of Public Works that it be ordained so.
Date: it. eg.t"
Construction er
BOARD OF PUBLIC WORKS APPROVAL Date:
Gary A, Gllot resident Suzanna M. Fritzberg, Member izabeth A. Maradik, Member
Therese J. Dora , Me er James A. Mueller, Member inda M. Markin,
Final Waiver of Lien
State ofkdiana, County of I , SS:
being duly sworn thathelshe is the &J-r
gismo ofOfficer)
(Title)
Of Qf . 1 VD544,Pjd_4_ having contracted with & TY �_ _�_ CJlJG�7 H � ►� 17
(Contractor) DeS l(g1J (Owner) ~�
to :lhmish certain materials and/or labor as follows; 1 a'<Cog- 10i, ni'�'�,�il�e
(Description) _
for a project known as
and owned by
04
(Name
and does hereby further state on the behalfofthe aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Dollars _($_ )
❑ receipt of which is hereby aelutowlodged; or
❑ the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver of Lienwhich 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) Lb t the final bal ce due from the contractor is the sum of
_a/1606. oo )
Q receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Mnal Waiver of Lien which shalt
become offeotive only uponreceipt of such payment.
THEREF0RE, the undersigned waives and releases unto the Owner of said premises, any and all lions or claims whatsoever
on the above-deserlbed property and improvements thateon an account of labox or material or both, furnished b the ten igued
thereto, subject to limitations or conditions expressed herein, ffany; and further cart no other party has an aien ox rie�ht to
Kett on account of any work performed or material famished to the undersigned saidpr ect, and wlthin the ope oftbis A13Cdav
Jana WalverofLlon.
(Firm) (Author; d Representative)
STATE OF 1NDIANA )
SS:
ST. JOSEPH C0UNT1C )
Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared
and acdmowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNJ SS WMEOF, I have hereunto subscribed my name and fixed my o al seal on the 2-9 day of
b V.9m a-2 - 200
otary Public Signature
My Commission Expiros; J�?L � ' Z 0 Z V
Residing ht aL 5 n?-A County, -- -- - ll4 b.J kq
OFFOAL SEAL
ALICE M. McKINLEY
NOTARY PUBLIC - INMANA
ST.JOSEPH COUNTY
My Comm. Expires 9/2612024
BOARD OF PUBLIC WORKS
AGENDA ITEM RE, VIEW REQUEST' FORM
Date 12/06/17 Department
Name Toy Villa Division/Bureau
Engineering
DPW
BPW Date 12/12/17 Phone Extension 5920
Required Prior to Submittal to Board
Legal F-1 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 El
Check the Appropriate Item Type -,Required for All Submissions
E] Agreement
F1 Contract El Proposal F-1 Addendum
F_]I Professional Services
Resolution
F1 Bid Opening
❑
Bid Award Req. to Advertise E] Title Sheet
F-1 Quote Opening
❑ Quote Award
F-1
Change Order No.
❑ C/O & PCA No. ❑ PCA
El
Ease/Encroach.
❑ Traffic Control, -
El
Other:
Required Information
Company or Vendor Name Fuerbringer Landscaping & Design, Inc.
New Vendor
MBE/WBE Contractor
MBEANBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
L] Yes N No H If Yes, Approved by
Purchasing
F1 MBE F-1 WBE
❑ No 0 Yes Name of Company D/a
2017 Tree Plantings
117-009B
MVH
202.0619.431.31.06
$19,000m
Terms of Contract
Purpose/Description Project Closeout
H Required Contractor's Certification Forms Attached (Non -
Collusion, Noin-Discri m i nation, Non -Debarment, E-Verify, Iran, etc.)
Required For Change Orders Only
Amount of increase $
El Decrease $
Previous Amount $
Current Percent of Change-, %
New Amount $
Total Percent of Change:
rsal After
Copy
Original
❑
R