HomeMy WebLinkAboutProject Completion Affidavit - MPAC Marquee Display Installation Proj No 117-070A - Burkhart Sign Systems LLC1316 COUNTY-0 IT BUILDING
227 W. JFFFERSON BOULEVARD
SOIFF11 BEND. INDIANA 4660 1 - 1830
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBIC WORKS
August 28, 2018
Charles Miller.
Burkhart Sign Systems, LLC
1247 Mishawaka Avenue
South Bend, IN 46615 ,
PHOM, 574/ 235-9251
FAX 574/ 235-9171
RE: Project Completion Affidavit — Morris Performing Arts Center Marquee Display
Installation — Project No. 11 7-070A
Dear Mr. Miller:
The Board of Public Works, at its meeting held on August 28, 2018, approved the Project
Completion Affidavit for this project in the amount of $34,600.
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
GARYA.CM,or SUZANNA M. FiuTZBFR(j Ei.,IZABETH A. MARADIK JAWs A. MUELLER Ti IERESE J. D()RAU
.111%1b' T764-
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME -Morris Performing Arts Center Marquee Display Installation
PROJECT NO 117-070A FINAL COST $34,600,00
CONTRACT SIGNED 12/21/2017 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Remove existing MPAC marquee displays and replace with new display.
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 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.
Execute day of 201 Burkhart Sign Systems, LLC
Company Name
Signature 1247 Mishawaka Ave
C Company Address
Printed Name South Bend, IN, 46,615
City, State, Zip
WITNESSES&
Before me, the undersigned Notary Public in and for said country and state, personally appeared
and acknowledged his/her signature to the above Project Completion Affidavit on
the day of (-Waq,&t -, 2011_y_.
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No A'9 < My Commission Expires
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frinfedA&m*8, 2626 t County of Residence "Qag"at
if the Corn1t m a dorp4ration , the following certificate will be executed.
BD 709077
certify that I am Secretary of the Corporation executing this release; that
who signed this release on behalf of the contractor was then
OF I of said Corporation; that said release was duly signed for and on behalf of said
CorporaVff*thority of its governing body, and is within the scope of corporate powers:
Secretary's Signature Corporate Seal
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
IL
This project is acceptable forfil al approval and we recommend to the Board of Public Works that it be ordained so.
Date:
Constructioe-Y alter
BOARD OF PUBLIC WORKS APPROVAL Date:
Gary A. Gilot, P , resident Suzanne M. Fritzberg, Member Elizabeth A. Maradik, Member
Therese J. DoFau, Member Ja I's A, Mueller, Member �eincla M. Marti , Clerk
b, C
State of Indiana, County of SS:
Kauit 'being duly sworn that he/she is the 66(o
'M Lt(?— —
(Name of Officer) (Title)
of IpV V, RAVC' '!;//,)U 5 il5 having contracted with
(Subcontractor/Supplier)
to furnish certain materials and/or labor as follows:
(Contractor)
for a project known as eAA /-6 � 9T'5 C00W /14AWyM �i5FLAJ /�Ot 464&
(Name of Project)
located at N, 1414164Aj -e :50ttM -9 o/4>. VJ 6 60 It
and owned by 5`0 U III
(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 ($
El 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,
(FINAL WAIVER) that the final balance due from the contractor is the sum of
($ Mlsz 0 C? )
El 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 It imitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a
*t lien on accou any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit
and ive ien.
1
.6
By
6L_o1-kA1,4,,te1 *F4n:a)_ :A&O, -(*uthorized-Rqresentafivft
STATE OF INDIANA
ST. JOSEPH COUNTY
Before me, the
and acknowledged the e
IN WITNESS I
Faso �13
SEAL -
080
OF 'I 14P.
Residing in .Q� County,
0 1
and for said County and State, personally appeared
jt and Waiver of Lien,
z
;qribed my name and affixed my official seat on the day of
200
Notary Public Sign
RUM.
k J
orina-7-1 ma,le—ner
Notary Public Name
Date 08/17/2018
Name Toy Villa
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Department
Public Works
Engineering
BPW Date 8/28/2018 Phone Extension 5920
Prior to Submittal to Board
Legal E] 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
H Agreement Amendment
0 Professional Services
El Bid Opening
F-I Quote Opening
0 Change Order No.
F-1 Ease/Encroach.
F] Other:
Company or Vendor Name
LJ Contract
F-1 Resolution
El Bid Award
F-1 Quote Award
0 C/O & PCA No.
F-1 Traffic Control:
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
INVA ,TOT
El Req. to Advertise El Title Sheet
101M
Burkhart Siqn, Systems, LLC
E] Yes H No EJ If Yes, Approved by
Purchasing
[:] MBE [:1 WBE
El No El Yes Name of Company
Morris Performing Arts Center Marquee Display Installation
117-070A
Morris Capital Improvement Fund
416.0404.453.43.08
$34,600.00
Project Closeout
F-1 Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
F Required For Change,Ordiers Otiyy
Amount of El increase $
❑j Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Cha
Copy
Original
0 Kara Boyles, City Engineer
❑mm Patrick Sherman, VPA
El
El