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Home My WebLink AboutProject Completion Affidavit - Century Center Fire Pump Replacement Project No 117-038 - Shambaugh and Son LP13 1 6 COUNTY-Cl FY 131AIJANG 227 WhITERSON Botju"wARD S01 ITH BEND. INDIANA 46601-1930 CIT)"OFSOUT" BEND PETEBUTTMEG, MAYOR BOARD OF PUBLIC WORKS September 25, 2018 Mark Manninen Shambaugh & Son, L.P. 56575 Twin Branch Drive, Suite A Mishawaka, IN 46545 PHOM,' 574/235-9251 FAX 574/ 235-9171 RE: Project Completion Affidavit — Century Center Fire Pump Replacement —Project No. 117-038 Dear Mr. Manninen: The Board of Public Works, at its meeting held on September 25, 2018, approved the Project Completion Affidavit for this project in the amount of $50,615. 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 GARN, A. Gii,o'i- SUZANNA M. Fiu1'ZB1-'.1i(-,i EIAZABL'11 i A. MARAD[K JAML�s A. MUELLER J. DoRAU CITY OF SOUTH BEND, INDIANA Aj BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Century Center Fire Pump Replacement PROJECT NO 117-038 FINAL COST $50.615.00 CONTRACT SIGNED 12/21/2017 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Installation of new fire and jockey pumps at the Century Center. WITNESSETH: The work Linder 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 tWq 3rd day of August .2018 Mark Manninen , N,ranch Manager Printed Name Corey A Barnes _Najary2j"o Seal State of Indiana St Joseph County My Commission Expires 0812812020 Shambaugh & Son, L.P. Company Name 56575 Twin Branch Drive, Suite A Company Address Mishawaka, IN 46545 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and slate, personally appeared Mark Manninen and acknowledged his/her signature to the above Project Completion Affidavit on the 3rd day of August .2018 Not Signature My Commission Expires Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. 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 Printed Name Corporate Seal DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for I proval and we recommend to the Board of Public Works that it The ordained so. Date: 3 Construction 4tiger BOAR7DrF P71131-11C WTKS APPROVAL Date: q a Gary A. Gil6t, President Suzanna M. Fritzberg,Member Elizabeth A. Maradik, Member Therese J. Dorau, Member James A. Mueller, Member M. Martin, ISA Form # 11-402 State of IN Frank D. Feichter PREPARE IN DUPLICATE Original - Contractor Duplicate - Subcontractor/Supplier AFFIDAVIT AND WAIVER OF LIEN final F-1 Partial L-] Payment to Follow County of Allen , ss� being duly sworn states that hie is the Treasurer Shambaugh & Son LP having contracted with City of South Bead Dept of Pub to furnish certain materials and or labor as follows Replace Fire Pump & BFP for the project known as Replace Fire Pump & BFP located at 120 Dr. Martin Luther King Jr. Dr S and owned by and does hereby further state on behalf of the aforementioned suibcointractor/supplier: (PARTIAL WAIVER) that there is due from the contractor the sum of on] Dollars receipt of which, is hereby acknowledged: or the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with, respect to said amount, and which waiver shall be effective only upon rec of payment thereof by the undersigned; (FINAL WAIVER) that there is dine from the contractor the sum of 15,0161.60 Dollars [ ] receipt of which is hereby acknowledged: or [he payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien of claim whatsoever on the above -described property and Improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any cliam or right to, a lien on -;eoUht of any work performed or material furnished" to the undersigned for said project, and e sco f !0ii idavit and waiver. By Treasurer Shambau_qh & Son LP z 7 -111, — Fran i D. Feichter WITNESS MiY HAND AND NOTARIAL SEAL, this 19, da/10 ul My Commission Expires 09/20/2020 Katheii 51affldlft)�en gy P V.......... Residing in Allen County S. KATHERIN ELAINE Owner: 1 HANSEN EXPI .-.19/20/20 OFt,1041111144111140 130ARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 09/13/2018 Department Public Wu arks Name Toy Villa Division/Bureau Engineering BPW Date 09/25/2018 Phone Extension 5920 Required Prior to Submittal to Board Legal El 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 Agreement Amendment Professional Services Bid Opening Quote Opening Change Order No. Ease/Encroach. Other: Company or Vendor Name Contract Proposal L] Addendum Resolution d Bid Award Req. to Advertise ❑ Title Sheet F-1 Quote Award E] C/O & PCA No. PCA F-1 Traffic Control: New Vendor MBEA/\IBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of H El Shambaugh & Sons, L.P. El Yes E] No [] If Yes, Approved by Purchasing, [] MBE F] WBE El No 0 Yes Name of Company Century Center Fire Pump Replace rn" �en t 117-038 Hotell-Motel Tax 7304.42010.000.0099 $50,615.00 ect Closeout F-1 Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Increase $ Decrease $ Previous Amount Current Percent of Change: New Amount Total Percent of Chancre: Copy Original F-1 F-1 El F]