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Home My WebLink AboutProject Completion Affidavit - 2017 Brick Column Repairs Proj No 117-126 - C&S Masonry Restoration1316 COUNTY-Crry BUILDING 227 W. Boul&"VARD SO[ 1111 HVN D. I NDJ ANA 46601-1830 CITY OF Soui'ii BEND PETE BurrIGIEG, MAYOR BOARD OF PUBLIC WORKS August 14,2018 Steve Fields C&S Masonry Restoration LLC 3725 N. Foundation Ct., Suite AB South Bend, fN 46628 P110M, 574/235-9251 FAX 574/ 235-9171 RE: Project Completion Affidavit — 2017 Brick Column Repairs — Project No. 117-126 Dear Mr. Fields: The Board of Public Works, at its meeting held on August 14, 2018, approved the Project Completion Affidavit for the above project in the amount of $11,493. 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 GARY A. Giw'r SUZANNAKFRITZBERo ELIZABETHA.MARADIK JAMB, A. MUELLER TI IER ESE 1. DORA LJ PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION W1ITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS 2017 Brick Column Repairs 117-126 FINAL COST $11,493.00 12/1212017 MAINTENANCE AGREEMENT ENDS Re air of two neighborhood brick columns. 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 this dOf -11 201 C&S Masonry Restoration,, LLC. w, . Company Name Signature 3725, N. Foundation Ct., Suite AB '-(e,) -e- Q"Uk Company Address Printed Name South Bend, IN 46628 City, State, Zip WITNESSESS: B f re me, too undersigned Notary Public in and for said country and state, personally appeared Vf. L S , and acknowledged his/her signature to the above Project Completion Affidavit on y of 201__,? Notary Signature My Commission Expires , ka- ar 1) VA Printed Name County of Residence N t MARSHA L, BROIL, fir, ot st juseph 5' 2021 If the Contractor is a corporation, the following certificate will be executed, 1, certify that I am Secretary of the Corporation executing this release; that 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 Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acce table for pproval and we recommend to the Board of Public Works that it be ordained so. 1� , r Date: ZA ConstructiorI alter BOARD, OF PUBLIC WORKS APPROVAL Date: A Gary A. Gifot, President ulaWn&M" ritzb(*g iber Elizabeth A, Maradik, Member Therese J. Dorau, Member James A. Mueller, Member llda M. Martin, Clerk' AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of S t , s , 5-R'y SS: cJ 1 e— :� t-e-.\k,5 being duly sworn that he/she is the i fkl e-5 `kl (Name of Officer) (Title) of CAS having contracted with C S UAL t�'� 0-1 ?.�?ems �'%Tie.vL tC . (Subcontractor/Su plier) (Contractdrr)f to furnish certain materials and/or labor as follows: 2 b `k `(_L�_ S kcA K) S for a project known as 2 0 �� 44�� CoC.y~,&O Re- •4 . +`S (Name of Project) located at and owned by C. t j cam- -D A-4 -... (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; RIVER) that the final balance due from the contractor is the sum of ❑ receipt of which is hereby acknowledged; or NI the payment of which has been promised as the sole consideration for this Aff davit 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 fin they certified that no other party has any claim or right to a Hen on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. n VA+5 6,J —t 04- kN—( u-c- By _Atcz� (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 -5-r�e and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN E S �OF,have hereunto subscribed my name and affixed my official se on the / day of-T,.,L�/ _96- 201 2 l I Notary Public Signature My Commission Expires: HA L, 11�0'JJf 4 f NotaryPublic, State of Ind n l ls' / ` ✓ �� Residing in �1 h County f �� r.ty of St!c�srp7 Notary Public Name F,l Hf—ni5simi 4,41846 Commission kxpires June 29, 2021 11 BOARD OF PUB1,IC WORKS AGENDA ITEM REVIEW INQUEST 07/24/2018 Tow Villa Department Enaineerin BPW Date — 08/14/2018_._.__.__._ ", 1 Phone Extension 5920 ------ 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 — Re,quired for All Submissions El Agreement El Contract E] Proposal F-1 Addendum F-1 Professional Services El Resolution F-1 Bid Opening E] Bid Award E] Req. to Advertise F-1 Title Sheet F-1 Quote Opening E] Quote Award - Possible F-1 Change Order No. F] C/O & PCA No. PCA 0 Ease/Encroach. F] 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 C & S Masonry Restoration, LLC EJ Yes 0 No E] If Yes, Approveg_ Z MBE 2 WBE El No El Yes Name of Company 2017 Brick Column Repairs 117-126 EDIT 408.1001.460.39.64 $ 11,493.00 Project Closeout F-1 Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Amount of El increase [:] Decrease Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Copy Original F-1 El 11 1-1 El El