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Home My WebLink AboutProject Completion Affidavit - Tucker Drive Project No 116-118A - Walsh and Kelly1316 COUN ['Y-CITY BUILDING 227 WJFTFER�ON Botiil"VARD SOUTH RFND. INDIANA 46601-1830 CFTY 01"SOUTH BEND PENT BUTT[GfEG, MAYOR BOARD OF PUBLIC WORKS October 9, 2018 Dustin Hilary Walsh & Kelly, Inc. 24358 State Road 23 South Bend, IN 46614 RE: Project Completion Affidavit — Tucker Drive — Project No. 116-118A Dear Mr. Hilary: P110W 574/235-9251 FAX 574/ 235-9171 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 $309,20,3,68. 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. GILOT SUZANNA M. FRI'I-ZBf-R(j EuZABE-Hi A. MARADIK JAMEs A. MUELLER THERF'SEP J. DORAU CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS '16 PROJECT COMPLETION AFFIDAVIT' PROJECT NAME -Tucker Drive PROJECT NO 116-118A FINAL COST $309,203.68 CONTRACT SIGNED 4/24/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Tucker Drive roadwav improvement and exnansion of turninu radii. M111110114*14111100 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 whichwri5)e a part of the above Contract. Executed this d gust Walsh & Kelly Inc, Company Name Signat 24358 State Road 23 Dustzvol'ary, VP of South Bend Area Company Address Prmted Name South Bend, IN 46614 City, State, Zip WITNESSES& Before me, the undersigned Notary Public in and for said country and state:, ersonaly appeared Dustin Hilary and acknowledged his/I , 11 1 R �o pletion Affidavit on the 27ft1. doyot I August 201 8 Notary Public, stets of Indiana St, Jos e p h Cou n ki My commission Expires Notary Signature JYIRmiss2qjL:0p&,202 2 e 5, 2 Alisha naLeger Printed Name County of Residence St, Joseph If the Contractor is a corporation, the following certificate will be executed, J. Michael Schaufn certify that I am Secretary of the Corporation executing this release; that Dustin Hilary who signed this release on behalf of the contractor was then d A-rpn of said Corporation; that said release was duly signed for and on Corp ation t city of I *0 ruing body, and is within the scope of corporate powers: bk, K E 1-4 .0 _r % Secretary's o J. Yel &Jiam Printed Name s 1. DEPARTMENT OF PUBLIC WORKS APPROVAL This project is gcceptable fol a pproval and we recommend to the Board of Public Works that it be I Date. ConstructiTJEger '%'-- BOARD J JDF PUBLIC WORKS PROVAL Date: I AM Gary A. GHot, President Suza6na M. Fritzberg, Member R,, 7- 11 1 1- -fl, A Maradik, Member Therese J. Dorau, Member James A. Mueller, Member M. Martin, :. i WHEREAS, the undersigned Walsh & Kelly,Inc. has been hereto employed by City of South Bend, Indiana to furnish certain material and labor, to -wit: PiRe and Concrete Work for the building owned by City of South Bend Indiana and Iodated on Tucker Drive South Bend 46619 St. Joseph County, Indiana Project # 116-11SA NOW, THEREFORE, KNOW YE, That the undersigned, for a good and valuable consideration, the receipt of which is hereby acknowledged, hereby and now waives and releases unto the said Corporation, the owner of said, premises, any and all lien, right of lien, or claim of whatsoever kind or character on the above described building and real estate, on account of any and all labor or materials, or both, furnished for or incorporated into said building by the undersigned„ and we further certify that the consideration moving to the undersigned for executing this WAIVER OF LIEN has been mutually giv and accepted as absolute cash payment and not as a conditii A rLIJJo ayment or as security for payment. $` inard delivered this September, 2018A��e HEL C. W� D *Hilary, South Bend Area Vice President Personally appeared bef a me this 17th day of September, 2018 Dustin Hilary who being duly sworn on oath, says: That he is the South Bend Area Vice President of the Walsh & Kelly, Inc. and that he hereby acknowledges the execution of the foregoing instrument for and on ehalf of said Walsh & Kelly, Inc. and at their special instance and request. My Commission Expires 06/07/2023 �'„_, This instrument prepared by: AET 4imyJElizabeth Turpin (Notary Public) �� rotary C�eblic, Skaie of InKPIN diana hAarshall County Camrnission Expires Jur:e 7, 2023 Surety 0 + 908.903.3485 202B Halls Mill Road, PO Box 1650 F + 908.903,3656 Whitehouse Station, NJ 08889-1650 Federal Insurance Company Maintenance Bond Bond No.MNT 8246-59-42 Amount$30,920.37 Rnow 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, (herelnunder 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 Thirty Thousand Nine Hundred Twenty Dollars and 37/100 ($30,920.37 }, 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 April 24 2018 for: Tucker Drive, Project No. 116-118A And WHEREAS, the said Principal is required to guarantee the Tucker Drive, Project No. 116-118A installed under said contract, against defects in materials or worlunanship, which may develop during the period to Form 15-02-0075FED (Rev. 5/17) NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall faithfully carry out and perform the saidguarantee, and shall, on due notice, repair and make good 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, Inc. By Of e4 L � 6•. 4W b� uJ•• p�� aoe••0ou m N, South Bend Area M M 9c VedeVal Insurance Com-pany gy M. Wahistrom *-.6ro- o ronn 15.02-0075FED (Rev. 5117) CHUBBe Power of Attorney Federal Insurance Company j 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 forand 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 or altering the some, and consents to the modification or alteration of any Instrument referred to In said bonds or obligations. Surety Bond Number: MNT 8246-69-42 Obligee: City of South Bend, Board of Public 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 on this 0 day of January, 2017. Dawn M. Chloros, Assistant Secretary 000 STATE OF NEW JERSEY County ofHunterdon ,&),- OA k�c' Stephen M, Haney, Vice President On this 6th day of January, =7 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 Attornay as Assistant Secretary of Bald Companies bylike authority; and thatshe Is acquainted with Stephen M. Haney, and knows him to be Vlce Presidentof said Companies; and that the signature of Stephen M. Haney, subscribed to said Power of Attorneyls In the genuine handwriting Of Stephen M. Haney, and was thereto subscribed by authority of Bald Companies and In deponents presence. Notarial Seal KATHBRINE 1 ADELAAR TAgy NOTARY PUBLIC OF NEW JERSEY I .... No. 231888E pfFBitG commmsfon fxpaae July 18, 2019 MiaryPublk P CERTIFICATION Resolutions adopted bythe Boards of Directors of FL'OERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016: 'RESOLVED, that the following authorizations relate to the execution, for and on behalf afthe Company, of hands, undertakings, recognizances, contracts and otherwritten commitments of the Company entered into In theordinary course ofbusloess (eacha'Wrltten Commltment'): (1) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and onbehalfoftheCompany, under the seal of the Companyor otherwise. (2) Each d4lyappointed attomey-In-ractofthe Comparylsbereby authorized to execute anyWrItten Commitment forand an beisairofthe Company, under the seal ofthe Campanyor otherwim, to thetAtnt thatsuchaction is authorizedby the grant of powers provided forinauch person's written appointment as such anorney-ln-fact (3) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, forand on behalfofthoCompanytoappoint Inwriting any person the attorney -In- tact of the Company with Nil power and authority to execute, for and on behatfofthe Company, under the seat of the Company or otherwise, such written Commitments of the Company as may be spedfied In such written appointment, which specification may be by general type or ctass of Written Commitments or by specification of one or more particular Written Commitments (4) FAch of the Chairman, the President and the Vice Presidents of the Company Is hereby &Uh)Drtzed, for and on beholfafthe Company, to delegate In writing to any otherofficer of the Company the authority to execute, for and on behalf of the Company, under the Company's seal or otherwise, such Written Commitments of the Company as are specified in such written delegation. which specillcatton may be by general type or class of Written Commitments or by specification ofoneormore particular Written Commitments (S) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the seal of the Company, may be aif€xed by facsimile on such Written Commitment or written appointment ordelegation. FURTHERMOLV90, that the foregoing Resoiuion shall not be deemed to be an exclusive statement oMe powersand authorkyol'officer-% employees and other persons to actforand on behalfofthe Company, and such Resolution shall notllmit or otherwfse affect the exercise *(any such power or authority otherwise validly granted or vested.' I, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby certifythat (1) the foregoing Resolutions adopted by the Board of Directors of the Companies are true, correct and in full force and effect, (11) the Companies are duly licensed and authorized to transact surety business in all SO of the United States of America and the District of Columbia and are authorized by the US. Treasury Departmentt 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 tt�Ij". 1ha foregoing Powerof Attorney Is true, correct and In full force and effect. (31�renulderm�han3ardseals ofsaid CompantesatWhitehouse Station, NJ, this (DC(ober2,2018, f Dawn M. Chloro IN THURVENT)OU Wl$N TO NOTIFY US OFA CLAIM, VERIFY TH6AVTH60TICITY OF THIS BOND OR NOTIFY USOFANY OTHERMATTK PLEASE CONTAC Telephone (90a)903.3493 Van (908) 903. 3656 e•malh sure"chubb.com Fotrr115 I¢ 0226s V GENJ PONSENT(reu 12.10) BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 9/27/2018 Department Public Works Name Toy Villa Division/Bureau Engineering BPW Date 10/09/2018 Phone Extension 5920 Legal 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 F-1 Professional Services ❑ Bid Opening ❑ Quote Opening Change Order No. F-1 Ease/Encroach. n Other: Company or Vendor Name LJ Contract H Proposal LJ Addendum F-1 Resolution 0 Bid Award ❑ Req. to Advertise El Title Sheet F-1 Quote Award El C/O & PCA No. PCA El Traffic Control: New Vendor MBE/WBE Contractor MBE/BE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Walsh & Kelly, Inc. El Yes Z No If Yes, Approved by Purchases L-1 MBE Ll WBE El No El Yes Name of Company Tucker Drive 116-118A RWTD 324.1050.460.31.02 $309,203.68 Project Closeout F-1 Required Contractor's Certification, Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc, Amount of F increase $ . . ...... El Decrease $ Previous Amount $ Current Percent of Change-, % New Amount $ Total Percent of Change: % 06MIZ7104= Copy Original F-1 ❑ F-1 1:1 1:1 El