HomeMy WebLinkAboutProject Completion Affidavit - West Race Emergency Repairs Proj No 115-115 - HRP Construction Co1316 COUNTY -CITY BUILIANO
227 W, JEFFERSON BOULF"VARD
scorn III --NI). INDIANA 46001-1830
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
August 28, 2018
Matthew Cain
HRP Construction Co.
5777 Cleveland Road
South Bend, IN 46628
Piiuqf,, 574/235-9251
FAX 574/ 235-9171
RE: Project Completion Affidavit —West Race Emergency Repairs —ProjqctNo. 115-115
Dear Mr. Cain:
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 $93,250,
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. Gim'r SUZANNA M. Mu'rztmw EtIZABE'ri-i A. MARANK JAMEs A. MUEHIHI THERESE" J. DORAU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME -West Race Frnergency Repair
PROJECT NO 115-115 FINAL COST $93,250.00
CONTRACT SIGNED 5/8/2018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION -Pour a concrete wall at the intake of the Century Center cascades, and reset cascade planks.
WITNESSETH:
The work under the above contract between the City of South Bond and the undersigned contractor having been compieted,
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.
s u
Execute "K 14 Ap c W 8 _'201 HRP Construction Co.
Company Name
Signature 5777CIeveland Rd
Matthew D. Cain, President
Printed Name
Company Address
South Bend, IN, 46628
City, State, Zip
WITNESSESS:
Before me, the undersigned Notary Public in and for said country and state, personally appeared
Matthew D. Cain , and acknowledged his/her signature to the above Project Completion Affidavit on
the 1.4th day0f August 201_ 8
Notary Signat&6 My Commission Expires
Cindy Vanheste
Printed Name
County of Residence
3/06/24
St. Joseph
If the Contractor is a corporation, the following certificate will be executed.
li Nancy K n a p i k certify that I am Secretary of the Corporation executing this release; that
Matthew D. Cain who signed this release on behalf of the contractor was then
President of said Corporation; that said release was duty signed for and on behalf of said
Corporation by Authority of its governing body, and is within the scope of corporate powers:
Secretar#rs Signature
Nancy Knapik
Printed Name
Corporate Seal
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is, acceptable f9r fi a pproval and we recommend to the Board of Public Works that it be ordained so.
Date:
Construction Mq9r6r
4 A, " "t BOARD OF PUBLIC WORKS APPROVAL Date:
Gary A. Gilot, President Suzanna M. Fritzberg, Member Elizabeth A. Maradik, Member
Therese J. Dorau, Member Ja4,s A. Mueller, Member qinda M. Martin, Clerk
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of S t . Joseph SS:
Nancy Knapik being duly sworn that he/she is the Secretary/Treasurer
(Name of Officer) (Title)
of HRP Construction Inc. having contracted with City of South Bend
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows: West Race Emergency Repair
(Description)
for a project known as West Race Emergency Repair
(Name of Project)
located at City of South Bend
and owned by City of South Bend,
(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;
(FINAL WAIVER) that the final balance due from the contractor is the sum of
Thirteen Thousand Thre Hundred Fifty Five Dollars and no/100 ($ 13,355).00
❑ 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 project, and within the scope of this Affidavit
and Waiver of Lien.
HRP Construction Inc. By �r�
(Firm) (Authox ze-d-Representative)
STATE OFINDIANA ) Nancy Knapik
SS:
ST, JOSEPH COUNTY )
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared n a n c y Knapik
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 1 4 t h day of
August 200 16
Notary Public Ignature Cindy V a n h e s t e
My Commission Expires: 3 / B / 2 4
Residing in S t . Joseph County, Indiana
Notary Public Name
BOARD OF PUBLIC WOIZICS
AGrENDA ITEM REVIEW REQUEST FOItM
Date 08/20/2018 Department Public Works
Name, Toy Villa Division/Bureau Engineering
BPW Date 08/28/2018 Phone Extension 5920
Legal El 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
H Agreement Amendment H Contract U Proposal LJ Addendum
n Professional Services n Resolution
El Bid Opening F-1 Bid Award El Req. to Advertise El Title Sheet
[:1 Quote Opening 0 Quiote Award
F-1 Change Order No. F] C/O & PCA No. M PCA
n Ease/Encroach. F] Traffic Control:
F-1 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
HRP Construction Co.,
West Race Emergency Repairs
115-115
Hotel -Motel
7304,42010,000,01099
$93,250.00
Project Closeout
LJ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Amount of ❑ Increase $
Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Dispersql After Appl9val
Copy Original
F-1 F-1
El F-1