HomeMy WebLinkAboutProject Completion Affidavit - Newman Center Window & Door Repair Proj No 117-001 - JW Werntz & Son, Inc.1316 C.OUN'ry-Cr y BUILDING
227 W. JEEFFE RSON 13O[TLE:`,VARD
:COI. ni 13��.ND, INDIANA46601-1830
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD iWORKS
January 23, 2018
Patrick Werntz
J.W, Werntz & Son, Inc.
1002 Derr Street
South fiend, IN 46601
IPHOW', 574J235-9251
FAX 574J 235-9171
RE: Project Completion Affidavit — Newman Center Window & Door Repair — Project
No. 117-00l
Dear Mr. Werntz:
The Board of Public Works, at its meeting held on January 23, 2018, approved the Project
Completion Affidavit for this project in the amount of $130,600.
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
GAR,Y A. Ci91.,o'r SIJZ" ANNA M. FRI'1ZBE;RG ELIZABEI'11 A. MARADiIK JAM : S A, MUELLER THERESE J. L7o AU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME
-Newman Center Window and Door Repair
PROJECT NO
117-001 FINAL COST $130,600.00
CONTRACT SIGNED
3/28/2017 MAINTENANCE AGREEMENT ENDS
Rremove existing exterior windows and doors from the building exterior and
installing new
PROJECT DESCRIPTION
storefront windows, storefront doors, and insulated metal doors.
LN19 1111111110 1 *S1*8111 M.1
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 hs Y111 day of "'Y"gea)z ivq 201 J.W. Werntz & Son, Inc.
MJA�z Company Name
Signature 1002 Kerr Street
&V12 Company Address
Printed Name South Bend, IN 46601
City, State, Zip
WITNESSES&
Before me, the undersigned Notary Public in and for said country and state, personally appeared
Ae0Wc/r' A)Lfdid Lff, and acknowledged his/her signature to the above Project Completion Affidavit on
the e,7i day of ZJV01) q 1/ 201 �'
Notary, itfriature My Commission Expires
County of Residence
Printed Ndme 5 ,
If the Contractor is a corporation, the following certificate will be executed.
1, )0jJTNj (° A' AA4dA1'7-k _, certify that I am Secretary of the Corporation, executing this release; that
1'47-AFIA' who signed this release on behalf of the contractor was then
-Aiix)cl-e- ive of said Corporation; that said release was duly signed for and on behalf of said
Corpor by Authority of its governing body, and is within the scope of corporate powers:
Secretary's Signature Corporate Seal
A j7 (-
--Z
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable fo final approval and we recommend to the Board of Public Works that it be ordained so,
Date:
Constructiop 'ItFriager
BOARD OF PUBLIC WORKS APPROVAL, Date: ld,31),
Gary A, Gilot, President Suzanna M,, Fritzberg, Member Eliza`Hlh A Viradik-, Member
11
Therese J. VbKu, Member
James A. Mueller, Member
M, Martin, Clerk
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of S7 d% e, E SS:
T i - E 41 17 being duly sworn that he/she is the f ra%,u✓
(Name of Officer) _ (Title)
C'r'/y `off S�eu�� ��ar/
of T_ j� r�_�Q�% �,�1r having contracted with �� �j,� 406dh-s
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows: e 1 Q 1 0) kaf a e iiv�' ;,4L,2D�i�S
(Description)
for a project known as q
(Name of Project)
Iocated at 17r,9 7 Y, 61C)-V LET If C412_1i LAJ -274f
and awned by OF J;M ZC/
(Owner)
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;
(FINALWAIVER) that the final balance due from the contractor is the sum of
_
❑ 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 an account of labor -or material or both, furnished b the undersigned
thereto, subject 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 said ject, and within the scope of this Affidavit
and Waiver of Lien,
`I Ct) Lt� LlV 1z ��t1` ®7i A) C By ~
(Firm) (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 AT�qi cf CC/t'it/!
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the �l�( day of
Not lic Sign
My Commission Expires:
_ ---�
Residing in7�LIO;j''`County,
— 1) Notary Public Name
Bond No, 463217P
MAINTENANCE BOND
KNOW ALL MEN sy 7HsE SS' PRESEN`tS, That we J. W. Werntz & Sons — In
as Pdnolpai, and Developers Surety and Indemnity Company as Surety, are held
and firmly bound unto City of South Ueod
227 W Jefferson South Bend IN 46601
as Obligee, in tite penal sum of Thirteen Thousand Sixty Dollars and 001100
($ U060.00
to which payment well and truly to be made we do bind ourselves, our and each of our heirs,
exacutom, administrators, successors and assigns jointly and severally, firmly by these presents.
WHEREAS, the said Principal entered into a contract with the City of South Bend
dated March 28. 2017
for Project 117-001 Newman Center Window and Door Repair
WHEREAS, said contract provides that the Principal will furnish a bored conditioned to guarantee for
the psHod of Three (3) year(s) after approval of the final estimate on said job, by the owner, a+gainat
all defects In workmanship. and materials which may became apparent during said period, and
WHEIWAS, the said oontract has been completed, and was approved on 4th
day of January, 2018
NOW, TNREPO RF, THE CANOITIAN OF THIS OBUGA'i'ION IS SUCH that, ff t;te Pi lncipal shall Indemnify
the Obligee for ail lose that the Obliges may sustafn by reason of any defective materials or
workmanship which beoorne apparent during the period of Threes yeagsj from and after
January 4, 2018 then this abligatlon snail be void, otherwlse to remain in full farce
and affect.
SIGNED, SEX D AND DATED c.
January 8, 2018 By. J. W. 71 )
V-0
t11;
,"'OL61110", (L•S.)
AND•`t�I...... ,
o��Re PRiNOiPAI.4S)
•• J.• �y"�
Develope Surety and lndemni y Company
1936
eat��om� by
'f111111,11 acie House Attorney -In -Fact
Surety Phone No. 800-782-1546
POWER OF ATTORNEY FOR
DEVELOPERS SURETY AND INDEMNITY COMPANY
INDEMNITY COMPANY OF CALIFORNIA
PO Box 19725, IRVINE, CA 92623 (949) 263.3300
i(NOWALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each
hereby make, constitute and appoint
Tracie House
as their true and lawful Attorney -in -Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of
suretyship giving and granting unto said Attorney -in -Fact full power and authority to do and to perform every not necessary, requisite or proper to be done in connection therewith as
each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attomey-in-Fact, pursuant to these
presents, are hereby ratified and confirmed,
Bond No. 463217P
Principal: J. W. Werntz & Sons, Inc.
Obligee: City of South Bend
This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY
AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2006.
RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Mce•Presldent orany Vice President of the
corporations be, and that each of them hereby Is, authorized to execute this Powerof Attorney, qualifying the attorney named In the Power ofAttomey to execute, on behalf of the
corporations, bonds, undertakings and contracts of suretyship; and that the Secrelaryor any Assistant Secretary of a therof the corporations be, and each of them hereby Is, authorized
to attest the execution of any such Power of Attorney,,
RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any corl€ficate relating thereto by facsimile, and any such
Power of Atlorneyor certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future With respect to any bond, undertaking
or contract of suretyship to which it is attached.
IN WITNESS WHEREOF, DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by
their respective officers and attested by their respective Secretary orAssistant Secretary this 6th day of February, 2017.
13V,,,....r7V A 4�`PANyO�
Y Daniel Young, SentarVice President 'V. i° CAW;,. G ��pa
a� 193b i ? OCT.6 c
's W. i8: 1$87
By. fro
Mark Lansdon, Vioe-President ..
'•.��a" ""`.yO�
A notary public or other officer completing this certificate verifies only the Identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange
On February 6, 2017 before me, Lucille Raymond, Notary Public
Date Here Insert Name and Title or the Olriwr
personally appeared Daniel Young and Mark Lansdon
Names) or $gner(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed
to the within instrument and acknowledged to me that helshelthey executed the same in hisfherftheir authorized
y�� capacity(les), and that by his/her/their signature(s) on the Instrument the person(s), or the entity upon behalf of
LUCILLE RAYMOND which the person(s) acted, executed the instrument.
Commission # 2081945
-+i Notary Public - California I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is
Orange County true and correct.
M Comm. Ex0lires Oct 13 201$
WITNESS my hand and official seal.
Place Notary Seal Above Signature
Luclll y and, Notary Public
CERTIFICATE
The undersigned, as Secretary orAssistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby
certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of
said corporations set forth in the Power of Attorney are in force as of the date of this Certificate.
„p4uugq
This Certificate Is executed In the City of Irvine, California, this 8th day of January 2018 qV AOQ,NeF,� 4Q�4P0 V p�
a yJoCs R1j_�2 :` b�kt
x c� 1936 = = 2 OCT. ;; �� 0
0.
Cassle J. rrisford, Assistant Se to
By: as �: W i8B7
ry
ATS-1002 (02i17)
CONSENT OF SURETY
TO F!,,NAL PAYMENT
.AIA Docunwnt G707
Bond No. 463217P
TO OVN R:
(Awne mdadrlit v)
City Of South Bend
227 W Jefferson
South Bend, IN 46601
PROJECT
(NrtmeAndud&v.%V.
Project 117-001 Newman Center Window and Door Repair
OWNER
❑
ARca-n ECT
❑
CONTRACTOR
0
SURETY
r7
OTHER
0
ARCHITECT'S PROJECT NO.:
CONTRACT FOR: Newman Center Window and Door Repair
CONTRACT DATED: March 28, 2017
in accordance with the provisions nitre Contract between the Ownerand the Contmetor as indimteEl above:, the
(Ilmnnameandaddmtsofsu, r�I
Developers Surety and Indemnity Company
P. O. Box 19725
Irvine, CA 92623
SURFTY,
on nand of
(Jmwn name and addrv&vgfCorPlnwimy
J. W. Werntz & Sons, Inc.
1002 Kerr St.
South Bend, IN 46601
CONTRACTOR,
hereby approves of the flnai payment to the Conti -actor, and agrees that final payment to the Contractor shall not relieve the Surety of
any of its obligations to
(Ift.wrrnatnaaadaddl &zgfQuvrcr)
City Of South Bend
227 W Jefferson
South Bend, IN 46601
as set foreh in said Surety°& bond.
, OWNER,
IN WiTNUS WHEREOF, the Surety has hereunto sett its hand on this date: January 8, 2018
(lrtsval tt� u�i�l�tg t11e �ua+hhfollaa+c�d ht+tfx u++rnur-lidRteairrl)�ar,)
(seal):
Onto)
rety and Indemnity Co
ofar+lbwy=4
Tracie House Attorney -in -Pact
(Afnted itame and tide)
Surety Phone No. 800-782-1546
C707 1994
POWER OF ATTORNEY FOR
DEVELOPERS SURETY AND INDEMNITY COMPANY
INDEMNITY COMPANY OF CALIFORNIA
PO Box 19725, IRVINE, CA 92623 (949) 263-3300
KNOWALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each
hereby make, constitute and appoint:
Tracie Mouse
as their true and lawful Attorney -In -Fact, to make, execute, deliver and acknowledge, far and on behalf of satd oorporations, as suretles, bonds, undertakings and contracts of
suretyship giving and granting unto said At€omay-in-Fact full power and authority to do and to perform every act necessary, requisite or properto be done In connection therewith as
each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorney -in -Fact, pursuant to these
presents, are hereby ratified and confirmed.
Bond No. 463217P
Principal: J. W. Werntz & Sons, Inc.
Obligee; City Of South Bend
This Power of Attorney is granted and Is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY
AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008.
RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Mce-President or any Vice President of the
corporations be, and that each of them hereby is, authorized to execute this Powerof Attorney, qualifying the attorney named in the Power of Attorney to execute, on behalf of the
corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of e€therof the corporations be, and each of them hereby is, authorized
to attest the execution of any such Powerof Attorney,
RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney orto any certificate relating thereto by facsimile, and any such
Powerof Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking
or contractof suretyship to which it is attached.
IN WITNESS WHEREOF, DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by
their respective officers and attested by their respective Secretary or Assistant Secretary this 6th day of February, 2017.
f ' �pq,d,rrr,
By !f �. +`',�{ANiD�y, p�VANYO
Daniel Young, SeniorVfce•President yo `oPQORt v�L�. !aG OpPOqCl
• 4
'• 1936 = 2 OCT. 6107
ri
o
Mark Lansdon Vice -President
A notary public or other officer completing this certificate verifies only the identity of the Individual who signed the
document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange
On February 6, 2017 before me, Lucille Ra mond Notary Public
Dale Here Insect New and Tole of the Olfieer
personally appeared Daniel Youna and Mark Lansdon
Name(s) ers(gner s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Islare subscribed
to the within Instrument and acknowledged to me that heishelthey executed the same in hislherllheir authorized
capacity(les), and that by hisfherltheir signature(s) on the instrument the person(s), or the entity upon behalf of
LUCILLE RAYMOND which the person(s) acted, executed the instrument.
Commission # 200191 i
I �r Notary Public - California I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
z Orange cour ty true and correct.
M Comm. Expires Oct 13 2018
WITNESS my hand and ofCclal seal. 9W4A
Place Notary Seal Above Signature
G44/7"
Lucill y and, Notary Public
CERTIFICATE
The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby
certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of
said corporations set forth in the Power of Attorney are in force as of the date of this Certificate.
' p
This Certificate Is executed In the City of Irvine, California, this 8th day of January 2018 ,+`��tj AN1)ANY
p11+ pe
yJ04��' c, v`Po t r
1936 = OCT, s
By: �L�/ = w• t�� W 1t187
Cassle J. rrisford, Assistant Se Lary '°�,.,oglrp� �� O p�
ATS-1002 (02/17) ,,;; u+ �` �,,, r #
BOARD OF PUBLIC WORKS
AGENDA ITEM RUA VIEW REQUEST FORM
Date
01/11/2018
Department
Public Works
Name
Toy Villa
Division/Bureau
Engineering
BPW Date
01123/2018
Phone Extension
5920
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 F-1
LJ Agreement
LJ Contract LJ Proposal LJ Addendum
El Professional Services
El
Resolution
F-1 Bid Opening
R
Bid Award E] Req. to Advertise Title Sheet
F] Quote Opening
F-1 Quote Award
F-1 Change Order No.
F C/O & PCA No. PCA
F
Ease/Encroach.
F-1 Traffic Control:
�
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
J.W. Wernitz & Son, Inc.
El Yes El No El If Yes, Approved by Purchasing
E] MBE [J WBE
n No El Yes Name of Company
Newman Center Window & Door Repair
117-001
REDATIF
429.1050AWA2.02
$130,600.00
Project Closeout
R Required Contractor's Certification Forms Attached (Non-
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.
Amount of F-1 Increase $
F-1 Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Copy
Original
D
El
F-1:1
F]