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Home My WebLink AboutProject Completion Affidavit - 2017 Code Enforcement Remodel Proj No 117-117 - Ziolkowski Construction Inc1316 COUNTY-Crry BwjnjN(j 227 W. JEFFERSON BOULEVARD Sourii BEND. INDIANA 46601-1830 CITY OF SOUTH BEND, PE'rE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS May 8, 2018 Bill Favors Ziolkowski Construction, Inc. 4050 Ralph Jones Drive South Bend, IN 46628 NMI: 574/235-9251 FAX 574/ 235-9171 RE: Project Completion Affidavit — 2017 Code Enforcement Remodel — Project No. 117- 117 Dear Mr. Favors: The Board of Public Works, at its meeting held on May 8, 2018, approved the Project Completion Affidavit for this project in the amount of $6,339. 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, 117 j( Linda M. Martin, Clerk Enclosure c: Toy Villa, Engineering THERESE J. DORAU GARY A. GiLo'r SUZANNA M. FRITZBERc; ELIZA 131I'l i A. MARA 1) 1 K J[Ami.,'s A. MUELLER EWA CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT GOMPLETIO,N AFFIDAVIT PROJECT NAME 2017 Code Enforcement Remodel PROJECT NO 117-117 FINAL COST $6,339,00 CONTRACT SIGNED 11/1412017 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Installation of two now walls, miscellaneous electrical, a,n(1_pq11ptiqg. WITNESSETH: The work Linder the above contract between the City of South Bond 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. Excled this 16th day of Aprlo 201.8 Zlolkowskl Construction Inc. Company Name —§'sgnature 4060 Ralph Jones Drive Bill Favors Company Address Printed Name South Bend, IN, 46628 city, State, Zip WITNESSES& Before me, the undersigned Notary Public in and for said country and state, personally appeared Bill Favors , and acknowledged his/her signature to the above Project Com DEBRA L JOHNSON the 16th day of A it 201 6 Seal 7Notary Public - State of Indiana M rs Notary Signature My Commission Expires March, 27, T24 Marshall County Mit Commission ExplFes Me 27, 2024 Debra L. Johnson Printed Name County of Residence if the Contractor Is a corporation, the following certificate will be executed, Charles Lewis certify that I am Secretary of the Corporation executing this release; that BRII Favors 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 Co,,plr 'on by A hority of its, verning body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal Charles Lewis Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable forfinapproval and we recommend to the Board of - Public Works that it be ordained so. ----f— NI�tbld Date: Construction �.ta�er BOARD OF PUBLIC WORKS APPROVAL Date, G I ary A. Gild, President -Su7anna M. Fritzborg, Member Elizabeth A. Maradilk, Member Therese J. Do(au, M&rnber J"7� A. Muellor, Member `Tlr�a M. Martin, ClerP Final Waiver of Linen state ofdndiana, County of St Joseph ss: Bill Favors being duty 4wom th4t he/she Is the President (lTWr e ofoftor) (Title) Of Ziolkowski Construction, Inc. having contracted with City of South Bend (Contractor) (Owner) Installation of two new walls, miscellaneous electrical and painting to furnish oultaltz materials ttridlor labor as follows: (besorlption) 2017 Code Enforcement Remodel for a projoctlsnowa as laono of Project) South Bend, Indiana located at City of South Bend and owned by ('Owner) and aloes hereby fertbar state on the behalf ofthe aforementioned sub 0oattactor/srappllert (pARTIAL'WtI.rM) that thore is due from the CoAtMotor the sum of Dollars 6� Q rvoolptofwwhlehis hereby aoltnowlodged; or E] the payment of which has boon proMhod us the Bola consideration for this Affidavit and Final Waiver of Lien vwhloh is glwon stalely with rospeotto said amount, and. Which waiver shalt be offoctivo only upon rovelpt of payment thereof by the undersigned; (FINAL WAVER), that the ffnal balance doe &arra the contraetor is the Sum of Three Hundred Sixteen and 951100 dollars 915'95 El � 1pt Of Which Is hereby admowledged; or El thepayntetat of which has boon promised as the solo consideration for this Affidavit and Final Waiver ofll Jett vwbioh shall beoomo off`4otivo onlynpoarocolpt ofsuoh payment. TIMM RE, the undersigned waives and rajlcases unto the owner of said promises, arty and all liens or claims whatsoever on tite above-deserlbed property and improvements thereon au account of labor ortunterial or both, ftfrnishod b the undersigned theretta, snblect to li mitatiotis or conditions oxpressed herein, if any, and further cortiflcdd thtrt no other Marty has any claim or right to a lien on account of work pexfolimod or material fttrnishodto the undersigned for sold project, and within the scope ofthis Affidavit and Waiver ofLis&. Zlol'kowski construction, Inc. J—'t� 2.2 (Firm) (Authorized Aepresontativo) STATS OF WDLVA ) } Ssc Before arse, the undorsigned, a notary Public, in and for sold Con* and State, personally appeared Bill Favors and aololtbwlodged the execution of the foregoing A£tidavlt and Waiver of Lien. — IN W17 NIRSS WNW0,11, I havo hereunto aubsorlbed my name and affixed my official soot on the �15th day of April 20 10 ��(�qk& X Notary Public signature My L0nrirnl$3l0n)Rxpir"' March 27, 2024 ll,ealdhig in Marshall County, Indiana Debra L. Johnson DEBRA L ,JOHNSUN seal Notary Public - State of Indians Marshao County Commission Expires Mar 27, 2004 BOARD OF PUB1,IC WORI(S AGENDA ITEM R14 VIEW RE, QUEST FORM Date 04/24/2018 Name Toy Villa Department Engineering BPW Date 05/08/20 18 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 El H Agreement Ll Contract Proposal ❑ Addendum F] Professional Services El Resolution Ej Bid Opening n Bid Award ❑ Req. to Advertise E] Title Sheet [:1 Quote Opening ❑ Quote Award F1 Change Order No. ❑ C/O & PCA No. PCA R Ease/Encroach. F-1, Traffic Control F-1 Other: Company or Vendor Name New Vendor MBEANBE Contractor MBEANBE Contractor Requested Project Name Project Number Funding Source Account INo. Ziolkowski Construction Inc. If Yes, Ar)r)roved by Purchasi I kyj 1 1.11 :111111 M RTWTJ Zq 0 El NoEl Yes Name of Company 2017 Code Enforcement Remodel 117-117 Consolidated Building Fund / Code Enforcement 600.1201.415.39,89 Amount $6,339.00, Terms of Contract Purpose/Description Project Closeout 0 Required Contractor's Certification Form Attached (Non - Collusion. Non -Discrimination, Non -Debarment. E-Verifv, Iran. etc. Amount of F-1 increase - $ El Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Dispersal After Approval Copy Original z F-1 Toy Villa F-1 F-1 F El