HomeMy WebLinkAboutProject Completion Affidavit - Leighton Parking Garage Entrance Repairs Project No 118-038 - Walsh and Kelly13 16 COUNTY -CITY BUILDING
227 W. JETFUASON 13mLENARD
SOUTH BFIND. INDIANA 46601-1830
0TY OF SOOT44 BEND PETE BUTTICAE.G, MAYOR
BOARD OFTUBLIC WORKS
October 9, 2018
Dustin Hilary
Walsh & Kelly, Inc.
24358 State Road 23
South Bend, IN 46614
Pi iom, ' 574/ 235-925 t
FAX 574/ 235-9171
RE: Project Completion Affidavit — Leighton Parking Garage Entrance Repairs — Project
No. 118-038
Dear Mr. Hilary:
The Board of Public Works, at its meeting held on October 9, 2018, approved the Project
Completion Affidavit for this project in the amount of $28,025.
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. Giwi' SUZANNA M. FRITZBf-',tw EuZABUni A, MARADIK JAMEs A, MUELU-1'R THERESE J. DORALI
CITY OF SOUTH BEND, INDIANA W
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME -Leighton Parking Garage Entrance Repair
PROJECT NO 118-038 FINAL COST $28,025.00
CONTRACT SIGNED 5/2212018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Remove and replace storm runoff drain.
WlTNESSETH:
The work under the above contract between the City of South Bond and the undersigned contractor having been completed,
the City of South Bend.149, officials and agents are hereby released from all claims and demands whatsoever arising under or
by such contract,,apd2tAt the con actor performed the work within the scope of the Specifications and Standards of the City
i, c of
of South Bend w ch re of the above Contract.
71" , 4 SePte Executed thi "a ��f -PbOf' 2018 Walsh & Kelly Inc.
Company Name
24358 State Road 23
Company Address
Name South Bend, IN 46614
City, State, Zip
WITNESSESS�:
Before me the undersigned Notary Public In and for said country and state, personally appeared
Dustin' Hilary and acknowledged his/her signature to the above Project Completion Affidavit on
the
nature
Alisha Kru
Printed Name
201 8
7 7L—SH—A KRUEGER
Notary
'Public,State of Indiana
EAL'i
st, J05 eph County
Mymi"iowliwpExpires
June 05.. 20,22-
June 5, 2022
County of Residence St. Joseph
If the Contractor is a corporation, the following certificate will be executed.
�i, J. Wchael ScMum certify that I am Secretary of the Corporation executing this
Dimin fh I= who signed this release on behalf of the contractor
YP of Soi±h..A--ud Are" of said Corporation; that said release was duly signed for an,ftq,,�vhdf tit 1��
Corporation b Au i of its I Zni body, and is within the scope of corporate powers: c.
Secretary's ature J! Michael Sdiaum
p
1W
16
J. chaum
ial
Sitc
Printed Name
1tviv\10
DEPARTMENT OF PUBLIC WORKS APPROVAL 010�§ J'go
This project is acceptable for fir I approval and we recommend to the Board of Public Works that it be ordained so.
Date:
Constructione,v g r
Gary A. GildIr, President
BOARD JOPUBLIC WORKS APPROVAL
Am�,4
'�tffanna M. Fritzberg, Krembdr
Therese J. Dorau, Member James A. Mueller, Member
Date: ✓0 A
Elizabeth A. Maradik, Member
"LWa M. Martin, Clerk
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of St. Joseph SS:
Dustin, Hilary being duly sworn that he/she is the South Bend Area Vice President
(Name of Officer) (Title)
of Walsh & Kelly, Inc. having contracted with Citv of South Bend, Indiana
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows: Plpe and Concrete Work
(Description)
for a project known as Leicihton Gara a Entrance Repair, Project #118-038
(Name of Project)
located at Leighton Pair[Kk!inct Garage, South, Bend, IN 46601
and owned by City of South Bend, Indiana
(Owner)
and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the surn 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 (lie stun of
Ll 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
became effective only upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises, anyand all lions 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.4tMIJUripy; and ftirther certified (fiat o other party has any claim or right to, a
lion on account of any work performed or materiqkAM*a koeth'i , ersign d e for said ect, and w' hin the scope of this Affidavit and Waiver of Lien,
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VORA7',� %
Z
Walsh & Kelly, Inc, 0, '-Byl
0-- epresentative)
(Firm) , kA�'.* _:-
STATE OF INDIANA
SS:
ST. JOSEPH COUNTY 00
ffo
it Notary Public, ilblil JjA id County and State, personally appeared Du Before rate, the undersigned, p Hilar 3(_
and acknowledged the execution of the lbregoing, Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed in i cal
0" of
September
200 18
WPotry —bffc—, 1—Si
My Commission Expires: June 07, 2023
Elizabeth Turpin
Residing in Marshall County, Indiana
AMY EUAIYPWTORP1
NctM Public, State of Indiana
Marshall County
Cornmis5ion Expires
June 7, 2Q?"
.r.�
Surety 0 + 908.903.3485
202B Hails Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, NJ 08889-1650
Federal insurance Company
Maintenance Bond Bond No.8246-60-12 Amount $2,802.50
Know All Men By These Presents,
That we,
Walsh & Kelly, Inc.
24358 State Road 23
South Bend, IN 46614
(hereinafter called the Principal), as Principal, and the FEDERAL INSURANCE COMPANY, a corporation duly organized
under the laws of the State of Indiana, (hereinunder called the Surety), as Surety, are held and firmly bound unto
City of South Bend, Board of Public Works
227 W. Jefferson Boulevard
South Bend, IN 46601
(hereinafter called the Obligee), in the amount of Two Thousand tight Hundred Two Dollars and 501100 (V,802.50 ),
for the payment of which we, the said Principal and the said Surety, bind ourselves, our heirs, Sealed with our seals
and dated this 2nd day of October, 2018.
WHEREAS, the said Principal has entered into a contract dated May 22 2018
for: Leighton Parking Garage Entrance Repair, Project No, 118-038
And
WHEREAS, the said Principal is required to guarantee the Leighton Parking Garage Entrance Repair, Project No. 118-038
installed under said contract, against defects in materials or workmanship, which may develop during the
period
to
Form 15-02-0075PED (Rev. 5/17)
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall faithfully carry out and
perform the said guarantee, and shall, on due notice, repair and makegood atits own expense anyand all defects in materials
or workmanship in the said work which may develop during the period to
or shall pay over, or make good and reimburse to the said Obligee all loss and damage which said Obligee may sustain
by reason or default of said Principal so to do, then this obligation shall be null and void; otherwise shall remain in full
force and effect.
Walsh & Kelly, 1
By
of South Bend
Federal Insurance Company
By
M. Wahlstrom
� J ®,00moc a°q° no°yp fJ fn'..
¢
a
AY'23'�'®
Form 15.02.0075FED (Rev. 5117)
CHUBE3a
Power of Attorney
Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC
INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Eric M, Wahlstrom
as their true and lawful Attorney -in -Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or
otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than ball bonds) given or executed in the course of business, and any Instruments
amending oraltering the some, and consents to the modification or alteration of any Instrument referred to In said bonds or obligations.
Surety Bond Number: 8246-60-12
Obligee: City of South Bend, Board of Publ€G Works
In Witness Whereof, said FEDERAL. INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these
presents and affixed their corporate seals onthis 6thdayof January, 2017.
Dawn M. Chloros, Assistant Secretary
*0o
STATE OF NEW JERSEY
County ofHunterdon SS,
Stephen M, Haney, Vice President
000
On this 6th day of January, 2027 before me, a Notary Public of New jersey, personally came Dawn M. Chloros, to me known to be Assistant Secretary of FEDERAL INSURANCE
COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Dawn M, Chloros,
being by me duly sworn, did depose and say that she Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY
COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said
Companies; and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and thatshe Is acquainted with Stephen M. Haney, and knows him
to be Vice President of said Companies; and that the signature of Stephen M, Haney, subscribed to said Power of Attorney is In the genuine handwriting of Stephen M. Haney, and was
thereto subscribed byauthority of said Companies and In deponenVs presence.
Notarial Seal
4(A'fHERINE J. ADELAAR
DfAgf
NOTARY PU6trC OF NEW JERSEY
.��.+
No. 2a19ee5
pGgLiC
Commission Expires July IQ, 261e NoiaryPubttc
,! R
CERTIFICATION
Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016:
'RESOLVED, that the follawingautborizatlons relate to the execution, for and on behalfof the Company, of bonds, undertakings, recognlzances, contracts and otherwr€tten commitments of the Company
entered into In the ordinary course of business (each a'Wrltten Commitment' ;
(1) Each of the Chairman, the President and the Vice Presidents of the Company Is hereby authorized to execute anyWr€ttenCommitment for and on behalrofthe Company, under the
seat of tha Company or otherwise.
(2) Path duly appointed attorneyin•faetaftheCompany€sherebyauthorizedtoexecutoanyWrlttenCommitmentforandanbehatfoftheCompany,underthesealoftheCompanyorotherwise,
to the extent that such action Is authorized bythe grant otpowers provided for in such person'swr[Wn appo[ntmentas such attorney -in -fact
(3) Path of the Chairman, the President and the Vice Presidents of theCompany is berebyauthotized, farand an behalfofthoCompanytoappoint lnwrtthtg any person the attorney -In -
fact of the Company with full power and authority to execute, for and on behalf of the Company, under the seal of the Company or otherwise, such written Commitments of the
Company as may be specified In such written appointment, which specification may be by general type or class of Written Commitments or by speclReadon of one or more particular
Written Commltmenta
(4) Each of the Chairman the President and the Vice Presidents of the Company lsherebyauthorlzed, for and on behalfof the Company, to delegate In writing toanyotheroMcerofthe
Company the authority to execute, for and on behalf or the Company, under the Company's seal or otherwise, such Written Commitments of the Company as are specified In suth
wrlttendelegatlon,which specification may be by general type or class of Written Commitments or byspeclRcationofoneormoreparttcutarWritten Commltments.
(5) The signature of any *Meer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the seat orthe Company, may be affixed by
facsimile on such Written Commitment or written appolntmentordelegatlon.
FURTHER RESOLVED, that the foregoing Resolution shalt not be deemed to bean exclusive statement of the powers and authority oloMcem employees and other persons to act for and on 4chalfor the
Company, and such Resolution shall notilre t or otherwise affect the exercise of any such power or authority otherwise validly granted or vested."
1, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby
certify that
(i) the foregoing Resolutions adopted bythe Board ofDlrectors ofthe Companies are true, correct arid In full force and effect,
(11) the Companies are duly licensed and authorized to transact surety business In all 50 of the United States of America and the District of Columbia and are
authorized by the US. Treasury Department; further, Federal and Vigilant are licensed in the U.S, Virgin Islands, and Federal Is licensed In Guam, Puerto Rico,
and each of the Provinces of Canada except Prince Edward Island; and
(ill) the foregoing Power of Attorney is true, correctandInfull force and effect
Given underrnyhand 'and seals of said Companies at Whitehouse Station, NJ, this October 2, 2018,
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
09/27/20,18
Department
Public Works
Name
Toy Villa
Division/Bureau
Engineering
BPW Date
10/9/201'8
. .......... . .. . .....
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
H Agreement Amendment
H Contract LJ Proposal Ll Addendum
F] Professional Services
El Resolution
0I Bid Opening
El Bid Award El Req. to Advertise El Title Sheet
F-1 Quote Opening
F-1 Quote Award
F-1 Change Order No.
F C/O & PCA No. PCA
F-1 Ease/Encroach.
F Traffic Control:
F-1 Other:
Company or Vendor Name
New Vendor
MBEIWBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
MIIMRMSEZ��
Walsh & Kelly, Inc.
0 Yes M No ❑ If Yes, Approved by
Purchasing
[:] MBE [:] WBE
El No 01 Yes Name of Company
Cei6hton Parking Garage Entrance Repair
118-038
Major Moves
412-0401-415,36-01
Project Closeout
E] Required Contractor's Certification Forms Attached (Non -
Collusion, Non Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Required For Change Orders Only
Amount of F-1 increase $
[:1 Decrease $
Previous Amount $
Current Percent of Change:
New Amount, $
Total Percent of Change: %
Dispersal After Approval
Copy
Original
F1
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F1
F1
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