HomeMy WebLinkAboutProject Completion Affidavit - Mishawaka Ave Roto Rooter Jetter Removal Project No 118-069R - Selge Construction1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1930
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAY
BOARD OF PUBLIC �'; - �-
November 13, 2018
Robert Kuhns
Selge Construction Co., Inc.
2833 S. I Ph St.
Niles, MI 49120
PHONE 574/ 235-9251
FAX 574/ 235-9171
RE: Project Completion Affidavit — Mishawaka Avenue Roto Rooter Jetter Removal —
Project No. 11 8-069R
Dear Mr. Kuhns:
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 $72,307.
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
CITY OF SOUTH BEND, INDIANA
Via'
BOARD OF PUBLIC WORKSz
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Mishawaka Avenue. - Roto-Rooter Jetter Removal Division 2
PROJECT NO 118-069R FINAL COST $72 307.00
CONTRACT SIGNED 7/10/2018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Removal and Replacement of elaht d'8'1 catch basins and inlets alono North Shore Drive
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�aa
js `C 5th dray of October , 201 8
Signature
Robert Kuhns, Project Eh ineer
Printed Name
Sel e Construction Co., Inc.
Company Name
2833 S. 11 th St.
Company Address
Niles, MI, 49120
City, State, Zip
WITNESSESS:
Before me, the undersigned Notary Public in and for said country and state, personally appeared
_Robert K�]Ytdas and acknowledged his/her signature to the above Project Completion Affidlpfloe a ...
the ... "1• t:h_ day o6 t ., 201 8
Notary Signature My Commission Expires
Vicki A. Priest
Printed Name
NOTAF
PUBLIC
07/25/2020 MYCCMMISSioN
rsa
7 25-2G20
Berrien �,� � I ��, N 6
If the Contractor is a corporation, the following certificate will be executed. 'ps T11111 0' ry
I, Vicki A ft.............. — ....... _............ certify that I am Secretary of the Corporation executing this release; that
........ who signed this release on behalf of the contractor was then
Prnj eat Engi neer of said Corporation; that said release was duly signed for and on behalf of said
Cor ration by Athori f its governing body, and is within the scope of corporate powers:
T
ocretary's Signat re
Corporate Seal
Vicki A. Priest
Printed Name
County of Residence
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for"fi al pproval and we recommend to the Board of Public Works that it be ordained so.
"" � Date:
Construction � a ,ger
Gary A. Gilot, President
BOARD OF PUBLIC WORKS APPROVAL Date. / / /,3 /�y (-1
erg„
Therese J. D rau„ ember James A. Mueller, Member
Elizabeth A. Mardik„ Member
,.° d14
C�-..m.
Linda. M. Martin, Clerk
Final Waiver of Lien
State of Indiana, as:
WHEREAS, the undersigned Sel ge Construction Co_ Inc, has been heretofore employed
by the City of South bend IN to furnish certain material and labor, to wit: South Fend Catch
basin Division 2 Pro"ect No. 118-069 for the real estate owned by the City of South Bend
located in South Bend, IN County of St. Joseph,
State of Indiana,
Now Therefore, Know Ye, That the undersigned, for and in consideration of Twenty Two
I'liouisand One llund'red Forty Seven 'dollars and Zero Cents ($22.147.001 the receipt of which
is hereby acknowledged, hereby and now waives and releases unto the said owner of said
premises, any and all lien, right of lien or claim of whatsoever kind of character on the above
described real estate. TO AND FOR SAID AMOUNT, an account of any and all labor material,
or both furnished for or incorporated into said real estate by the undersigned up to this date, and
we further certify that the consideration moving to the undersigned for executing this Final
Waiver of Lien has been mutually given and accepted as final payment to or on account of the
said project for said real estate.
Signed, sealed and delivered this 15th day of October, 2018
ml
Signed—....!
Robert l uhns, Project Engineer
Personally appeared before me this 15th day of October, 2018, Robert Kuhns, who, being duly
sworn on oath, says: That he is Pro°ect En linee,r of the Sel ge Construction Co. Inc. and that he
hereby acknowledges the execution of the foregoing instrument for and on behalf of said Sere
Construction Co., Inc.
My Commission expires:
Notary Public w�arrrrrrrrrruA
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BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 10/17/2018
Name Thy _Yi I I a . ... . ..... Department Engineering
BPW Date 11/13/2018 Phone Extension 5920
AM-
.......... ...
--- Required Prior to Submittal to Board
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
.......................... ............
Check
F-1 Agreement
Ej Professional Services
❑ Bid Opening
Quote Opening
E] Change Order No.
n Ease/Encroach.
... . ..........
ie Appropriate Item Tepee — Re
.... . . .. . ....
n Contract
F-1 Resolution
El Bid Award
n Quote Award
El C/O & PCA No.
n Traffic Control
Douired Info
Proposal
El Req. to Advertise
Addendum
El Title Sheet
F-1 Required Contractor's Certification Form Attached (Non -
Collusion, Non Discrimination, Non Debarment, E-Verify Iran etc.)
Required For Change Orders Only
. . . . .................
Amount of r_1 increase $ ................ . . ....
El Decrease $
Previous Amount t
. ... . .......
Current Percent of Change: %
New Amount
. . . . . ........... . . .....
Total Percent of Change: %
Dispersal After Approval
Copy
Original
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