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HomeMy WebLinkAboutProject Completion Affidavit - FLIR Traffic Cameras Divisions A B and C Project No 117-122 - Pemberton Davis Electric1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOT ITH BEND. INDIANA 46601-1 930 CITY OF • BEND PETE BUTTIGIEG, MAYrn' BOARD OF PUBLIC WORKS November 13, 2018 John Ferro Pemberton Davis Electric, Inc. 916 E. McKinley Avenue Mishawaka, IN 46545 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — FLIR Traffic Cameras, Divisions A, B and C — Project No. 117-122 Dear Mr. Ferro:, The Board of Public Works, at its meeting held on November 13, 2018, approved the Project Completion Affidavit for this project in the amount of $111,848. 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 . FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS r r" 7, ✓ `� PROJECT COMPLETION AFFIDAVIT PROJECT NAME FLIR Traffic Cameras Div.A,B C PROJECT NO 117-122 FINAL COST $111,848.00 CONTRACT SIGNED 12/21/2017 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION 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. Executed this 1 day of 20ts L/ ignature Printed Name Pemberton Davis Electric, Inc. Company Name 916 E. McKinley Ave. Company Address Mishawaka, IN 46545 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared the day oC J� g j kry ca�tbi VHAIMBAUGH i �— St, and acknowledged histher signature to the above Project Indiana -pat:3Pr� 201 Y State of s ph County SEq� Commisscoru # 632698 MY CGMMr ssion 'as Not Signature My Commission Expires " ` " Febrursr 0 0 AM Printed Name County of Residence If the Contractor is a corporation, tjhe 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 Aut city gf itygoveming body, and is within the scope of corporate powers: Secretary's Signature - Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable fo fn approval and we recommend to the Board of Public Works that it be ordained so. Date: - 1 Construction �rg�er BOARD 0; PUB IC WORK AP ROVAL Date. 11,1131,4ca ._ 1 �,"Y1,6i Gary A. Gilot, iPr ident anna M, Fritzberg, Member eth A. Maradik, Member Therese J. Dotau� em� , ber James A. Mueller, Member —Linda M. Martin, Clerk MAINTENANCE BOND Bond No. 2855042 KNOW ALL BY THESE PRESENTS, That we Pemberton -Davis Electric, Inc. 916 E. McKinley Ave, Mishawaka, IN 46546 as Principal, and Great American Insurance Company, 301 E. 4th Street, Cincinnati, OH 45202 a as Surety, are held and firmly bound unto City of South Bend, Department of Public Works, 227 West Jefferson Blvd, Ste 1300 N, South Bend, IN 46601 as Obligee, in the penal sum of Eleven Thousand One Hundred Eighty -Five & 00/100--------- ----- ------ ----- - -- -------------------------------------------------------- -_------...._..,...,,.. ------------ ($ 11,185.00 to which payment well and truly to be made we do bind ourselves, our and each of our heirs, executors, administrators, successor and assigns jointly and severally, firmly by these presents. WHEREAS, the said Principal entered into a contract with the City of South Bend, Department of Public Works dated 12/21/2017 for FUR Traffic Cameras (Div.A,B,C), Project No. 117-122 WHEREAS, said contract provides that the Principal will furnish a bond conditioned to guarantee for the period of three (3) year(s) after approval of the final estimate on said job, by the owner, against all defects in workmanship and material which may become apparent during said period, and WHEREAS, the said contract has been complete, and was approved on 3rd day of June 2018 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION 1S SUCH that, if the Principal shall indemnify the Obligee for all loss that the Obligec may sustain by reason of any defective materials or workmanship which become apparent during the period of three(3) year(s) from and after June 3, 2018 then this obligation shall be void, otherwise to remain in full force and effect. SIGNED, SEALED AND DATED 30th day of October 2018 Pemberton -Davis Electric, Inc. PRINCIPAL(S) (I-S.) (L.S.) Grea�American Insurance„ Company Y B Lyntte Long�Attorney-in-Fact 000591 12100 GREAT AMERICAN INSURANCE COMPANY@ Administrative Office: 301 E 4TH STREET • CINCINNATI, OHIO 45202 0 513-369-5000 • FAX 513-723-2740 The number of persons authorized by this power of attorney is not more than ELEVEN No.0 20754 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than one is named, its true and lawful attorney -in -fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond, undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below. Name Address Limit of Power DEBORAH NEICHTER LYNNETTE LONG ALL OF ALL JILL KEMP SHERYON QUINN LOUISVILLE, KENTUCKY $100,000,000 LEIGH MCARTHY THERESA PICKERRELL BARBARA DUNCAN AMY MEREDITH MARK A. GUIDRY MARGIE M. LOWRY SANDRA L. FUSINETTI This Power of Attorney revokes all previous powers issued on behalf of the attomey(s)-in-fact named above. IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this 27TH day of JUNE 1 2017 Attest GREAT AMERICAN INSURANCE COMPANY k/2- Assistant Secretary Divisional Senior lice President STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVID C. KiTCHiN (677-377-2405) On this 27TH day of JUNE 2017 , before me personally appeared DAVID C. KITCHIN, to me known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his name thereto by like authority. �r ✓wW� , u � „„a o„ r F .#elt This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company by unanimous written consent dated June 9, 2008. RESOLVED: That the Divisional President, the several Divisional Senior Vice Presidents, Divisional Vice Presidents and Divisonal Assistant Vice Presidents, or any one of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof- to prescribe their respective duties and the respective limits of their authority; and to revoke any such appointment at any time. RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the Company may be affixed by facsimile to anypower of attorney or certificate of either given for the execulion of any bond, undertaking, contract cif suret shop„ or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signalurea of stic'h officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. CERTIFICATION I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect. Signed and sealed this 30. day of (Dr _ Oj� l l d Assistant Secretary mm, S1029AF (06/15) Final Waiver of Lien State oflndiana, County of �� V O SS: J O" n, -Fe.^ being duly sworn that he/she is the A-c b5 ' h (Nam off Officer) �,� j1 (Title) Of �� to kng contracted wiHr C l l� ok S,ik lie (Contractor) (Owner) to fiunish certain materials and/or labor as follows: A'Lz, C1 Z'7 t'. I (Description) for a project known as (Name of Project) located at and owned by (owner) and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: (PARTIAL, WAIVER) that there is due from the Contractor the sum of Dollars ❑ receipt of which is hereby aclaxowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lienwhich is given solely with respect to said amount and which waiver shall be efiective only upon receipt of payment thereof by the undersigned; (FINAL. WAIVED that the final balance due from the contractor is the sum of J J ., ❑ receipt of which is hereby acknowledged; or 'f ` the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective on(y upon receipt of such pagyment.. TIMMORE, the underalgined 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 herain, if any; and fin their 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 acid project; and within the scope ofthis Affidavit and Waiver ofI.Aen. 16l (Firm.) t 71od eps�ascntativq) STATE OF INDIANA ) SS: ST. JOS13PH COUNTY } Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared " and admowledged the execution of the foregoing Affidavit and Waiver ofLien. IN WITNESS" WHEREOF, I have hereunto subscribed my name and affixed my official seal on the - 17 � day of '' 200 1+1 Publlta graatauo My Commission Expires: ZA2 1We HW g • �.Y Y� 6 F��u N Ai w0.i� Resldin m T County, �. l+la py My Commission Expires February 02, 2020 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 10/23/2018 Department Public Works Name Toy Villa i4 Division/Bureau Engineering .._..____... _ _..___ _.. __m............ — - ..—ww_-........- BPW Date 11 /13/2018 Phone Extension 5920 i �� •Ww•� ��,����;�wuHuuuumpuoHiHiHumr�ir�r�w��r������+;� �,¢ra� �,^�swvv^a a.e�aaatrwrerr.. ,rr:��w:..m ����� � ,„,� rw,�;mormwxm�rv�arv�n.�ir�:�,,rv,�p aU,����+�+.;n�uwlluw� � � ;�rrr. -µ- R uired Prior to Submittal to ,��..m ,� _._.. .....����. .. Board .� �....... m_... ....._ ...... -ww. 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 El Check the, Agreement - Amendment ent Professional Services ❑ Bid Opening ❑ Quote Opening Change Order No. O' Ease/Encroach. [❑ Other: Company or Vendor Name LJ Contract [� Resolution [� Bid Award ❑ Quote Award ❑ C/O &PCANo ❑ 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 Amount of ❑ Increase ❑ Decrease Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: /o Copy Original F1 ❑ )r All Submissions Proposal ❑ Addendum E Req. to Advertise ❑ Title Sheet ® PCA n Pemberton Davis Electric, LLC, Project Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination,. Non -Debarment., E-Verifv, Iran, etc.