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Home My WebLink AboutProject Completion Affidavit - 2017 Engineering Remodel Proj No 117-116 - Ziolkowski Construction Inc1316 COUNTY -CITY BUILDING 227 W. JEFFEMSON BOULEVARD Soui'H BEND. INDIANA 46601-1930 CITY OF Souni BEND PETEBUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS May 8,, 2018 Bill Favors Ziolkowski Construction, Inc. ,4050 Ralph Jones Drive South Bend, IN 46628 PHONE 574/235-9251 FAX 574/ 235-9171 RE: Project Completion Affidavit — 2017 Engineering Remodel — Project No. 117-116 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 $, 13,3 92. 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, A 4-- lt,( Linda M. Martin, Clerk Enclosure c: Toy Villa, Engineering GARY A. Gii.o-r SUZANNA M. F1Z11ZB13R(,# EiRABrti,ii A. MARADIK JAw,'.s A. MUELLER THI",,'RESE J. DORAU CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME 2017 Engineering Remodel PROJECT NO 117-116 FINAL COST $13,392.00 CONTRACT SIGNED 11128/2017 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Demolish existing kitchen and Install new cabinets, countertop, water cooler, and plumb fixtures 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 dalms 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 Bond which were a part of the above Contract. Ex:e2cu'ed this 16th - day of April 2018 Zloilkowski Construction Inc. Company Name 44r�' �J Signature 4050 Ralph Jones Drive Bill Favors Company Address Printed Name South Bend, IN, 46628 City, State, Zip WITNESSESS: Before one, the undersigned Notary Public in and for said country and state, personally appeared Bill Favors , and acknowledged his/her signature to the above Project Completion Affidavit on 161h April 6tho y Notary Signature My Commission Expires March 27 Debra L. Johnson Printed Name County of Residence Marshall DEBRA L JOHNSON Seal q0tary public - Slate ot Indiana lairsll uOunly commission Exptr es Mar 27, 2024 If the Contractor is a corporation, the following certificate will be executed, 1, Charles Lewis certify that I any Secretary of the Corporation executing this release; that NO Favors who signed this release on behalf of the contractor was then realdent of said Corporation; that said release was duly signed for and on behalf of said Cor on by horltylis governing body, and is within the scope of corporate powers: L It 7c, l� Secretary's Slgnatune- Corporate Seal Charles Lewis Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project Is acceptable for fi pproval and we recommend to the Board of Public Works that it be ordained so. C'—= Datw ct - I Construction tqjgYger BOARD OF PUBLIC WORKS APPROVAL Date: Gary A. Gilot, President Suzanna M. FrItzberg, Member Elizabeth A, Maradlk, Member Therese J. Do au Member Mueller, Member Li da M. Martin, Clerk Final Waiver of Lien State ofhadtana, County of St Joseph SSt Bill Favors being duly swom that he/she is the President (Name of Officer) (Title) Of Ziolkowski Construction„ inc. Having contracted with City of Soth Beni (Contractor) (Owner) to iiurlish certain materials and/or labor as follows: Demolish existing kitchen and install now cabinets, countertop„ water cooler and plumb fixtures (I)e�erlpdon) 2017 Engineering Remodel for a projeot%town as (Name ofAmject) located at South Benxi, Indiana and owned by City of South Bend (Owner) and does hereby "or state on the behalf ofthe atforornentioned suboontnotor/supplier., (PA.RVAL WAMR) thatthom is due froin the CoAtrootor the sum of Dollars ( ) d rccelpt of which is hereby acluiowleaigod or 0 the payeaneaat of which has been prouslsed as; the sole consideratlon for this Affidavit and Flunl Waiver ofLienwhich is given solely with ruspuutto said amoont, anal which we Ivor shall be effective only upon reoelpt of payment thereof by the undowigned; (FINAL' AIV tJ thatthe fival balance due from tho contractor is the sum of ** Twe Thousorrd Four Hundred Three and 351100 *` ($ 2,403,35 ( recelpt oft Bich is hereby acllartowlecdpad, or d thepaymentot'Whj0hhas boon prcWiodfistiiteSolo consideration for this A davitand.FilialWaiverofLitnr,whichshall boorm o otl'cotivo onlytapoill.xeocipt ofauola payment, TIMWORB, the underolgnud waives and releases unto the Civmor of said premises, any and all lions or claims whatsoever on tho abovic-deserlbcd prepexty and improvements thereon an atzrmt rs(labor ar m�terlal or both, lilrnislaud ly the utadersig>�ed thereto, subject to limitations crr conditions oapressed herons, ifany, and fhrther certlFAW thatno ether patty has any cloittt or rightto u. lion on acconlnt of'any work pertirrrrnaed or material Mmished to the undorslguetl for ealdpr�oot, and wIthin the scope of this Affidavit said Waiver of Llest. Ziolkowski Construction, Inc, " (Firm) (Autborixedliopmso °^V y trm ntivo) STATE OF MIA` 4A ) } SS; ST, 30SEPH COUNTY Bill Favors Before me, the undersigned, a'Nvtov Publio, in and for said County and State, personally appoared and afaowledged the execution of the foregoing Affidavit and Walvoar of Lion, IN WI'1`l' B aS 'WXR OF,1 havo hereunto subscribed my name and of xS ed any official seal on the 1 t th day of April 20 18 s Nowt' Publio Signature MyC'vmaat3ssipnM fret': March 27,2024 Debra L. Johnson Residing irk Marshall County, Indiana �,�. ,13EJ NSONte of Indianaountyes filar 27, 2024 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM late 04/23/2018 Name Toy Villa Department Engineering BPW Date 05/08/2018 Phone Extension 5920 Required Prior to Submittal to Board Legal F-1 Attorney Name Controller El 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 f6rAH Subr issions F-1 Agreement F-1 Contract [:1 Proposal El Addendum F-1 Professional Services F-1 Resolution F-1 Bid Opening F-1 Bid Award E] Req. to Advertise F] Title Sheet ❑ Quote Opening n Quote Award Change Order No. El C/O & PCA No. PCA ❑ Ease/Encroach. ❑ Traffic Control F-1 Other: 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 F-1 El Ziolkowski Construction, Inc. EJ Yes H No [:1 If Yes, Approved by Purchasing F-1 MBE F-1 WBE 2017 Engineering Remodel 117-116 Building et Maintenance 101.0602.431.36.01 ;0919 pe WITt Project Closeout F-1 Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. Increase $ Decrease $ Previous Amount Current Percent of Change: New Amount Total Percent of Change: Dispersal After Approval Copy Original F-1 F] F] n El El