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HomeMy WebLinkAboutProject Completion Affidavit - 2018 Curb and Sidewalk Construction Project No 118-007 - Premium Concrete Services Inc1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BFND_ INDIANA 46601-1930 o � r lk ACE 1865 EN HIS'il 1 SOMIJOHN ' November 27, 2018 Becky Yeakey Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 PHONE 574/ 235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — 2018 Curb and Sidewalk Construction— Project No. 118-007 Dear Ms. Yeakey: The Board of Public Works, at its meeting held on November 27, 2018, approved the Project Completion Affidavit for this project in the amount of $36,160. 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. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DoRAu CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT f� PROJECT NAME 2018 Curb and Sidewalk (Division 132)............ mm _ PROJECT NO 118-007 FINAL COST $36,160.00 CONTRACT SIGNED MAINTENANCE AGREEMENT ENDS Remove and replace concrete sidewalk, curb, curb ramps, and approaches at various locations PROJECT DESCRIPTION within the Citv of South Bend, IN. 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. Exec, this y of 1 ,k6,P�' 201_ Premium Concrete Services, Inc. Company Name S nature' Company " Address Printed Nam City, State, Zip I� WITNESSES& Before me, the undersigned Notary Public in and for said country and state, .L:tA�"9 "I G4 K L--"q „ and acknowledged his/her signature to the above f the R -tN day of ' E , 201_E_. tary Signature My Commission Expires Printed Name County of Residence ect CompletiorJ NER NOTARY PUBLIC SEAL COUNTY, STATE OF INDIANA PIES FEBRUARY 12,2026 If the Contractor is a qorporation, 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 ll °'' of said Corporation; that said release was duly signed for and on behalf of said Corporatlo Authority of its governing body, and is within the scope of corporate powers: Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This proy acceptable for inc pproval and we recommend to the Board of Public Works that it be ordained so. Date: Constructi lager BOARD OF PUBLIC WORKS APPROVAL Date: Gary A. Gilot, President Suz n �.rriitz�berg, ember Elizabeth A. Maradik, Member �� Therese J. Dorau, Mem er Jamesm�A. Mueller, Member t a M. Martin, C,P om .- . tk * * * * MAINTENANCE BOND Bond No,MNT2420231 KNOW ALL MEN BY THESE PRESENTS: That, Preniho n Conde Services, Inc,, 712 Rich and Sr„ Elkhart, I 46516 as Principal, and Old Republic Insurance Company a corporation organized under the laws of the State of Wisconsin and authorized to do a surety business in the State of Indiana as Surety, are held and firmly bound unto the City of'South mend Board of Public Forks as obligee in the sum of Three Th ($3,616.00 ), lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents: SEALED with our seals and dated this 8th day of November 2018 WHEREAS, on the l Oth day of July , 2018 , the said principal as contractor, entered into a contract for: 2018 Curb and Sidewalk Construction, Project No. 118-007 for the sum of Thirty-six Thousand One Hundred Sixty And No/100 ($36,160.00 I; and, WHEREAS, under the tenns of the specifications for said work, the said principal is required to give a bond in the amount of Three Thousand Six Hundred Sixteen And No/100 ($$3,616.00 ),to protect the obligee against the result of faulty materials or workmanship for a period ofThree (3vear(s) from and after the date of the completion and acceptance of same, namely, until .11/5/2021 Now, THEREFORE, if the said principal shall for a period of Three (3kear from and after the date of the completion and acceptance of same by said obligee replace any and all defects arising in said work whether resulting from defective materials or defective workmanship, then the above obligation to be void; otherwise to remain in full force and effect. Premium Concrete Services, Inc. BY CV50Peol Principal Old Re ublic Insurance Com an ;��lrety By l"enniferL.Kasmia Attorney -in -D'art ORSC 22518 (4-93) lw 22851 0I,,D REPUBLIC INSURANCE COMI"ANY .w-------- -. ---- ...wwmw.............. � .. ..... .�a�... ... POW.. ER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make, constitute and appoint: NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIBER, CHERYL E. ALKIRE, OF SOUTH BEND, IN its true and lawful Attorney(s)-in-Fact, with full power and authority, not exceeding $50,000,000, for and on behalf of the Company as surety, to execute and deliver and affix the seal of the Company thereto (If a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, tother than s0i"Ansurance, workers compensation bonds guararnteeing paymerut of bernefit„ , asbestos, aboterneral contract bonds„ waste manage- ment bonds, hazardous waste remedtratlon bonds or blacks hung bounds), as follows' ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED FOUR MILLION DOLLARS($4,000,000)---------- —.... ------ FOR ANY SINGLE OBLIGATION. and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attomeys-in-Fact, pursuant to these presents, are ratified and confirmed. This document is not valid unless printed on colored background and is multi -colored. This: appointment is made under and by authority of the board of directors at a meeting held on March 14, 2014, This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on March 14, 2014. RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surety division, in conjunction with the secretary or any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate, Powers of Attomey in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings, rem nuances and suret sht obligations of WI kinds„ o fter than ball bonds, bank depository bonds, mortgage deficiency br.�rs ids m�'ortgage guaranty onds, guaranteos o , Insailinent papwr and note guairar0y boi nds. The said officers may revoke any Power of Attorney previously granted to any such person. The authority of any Power of Attorney granted by any such officer of the Company as aforesaid shall not exceed fifty million dollars ($50,000,000.00), except (a) bonds required to be filed as open penalty bonds, and (b) bonds filed with any court or governmental authority requiring an unlimited penalty in bonds filed in that court. RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the chairman, president or any vice president of the Company's surety division and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (it) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required). RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this ­_ITm 11TH .-„ n day of JTUE . 2018. OLD REPUBLIC INSURANCE COMPANY nBai s m Rta SEAL ,ly STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS Vice""1p1°"" President On this 11TH day of, JUNE, 2018 personally came before me, ___ALAN PAVLIC and JANE E CHERNEY ..... to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said organization. 8 9/2 s " My commission expires: ry 9/2 /18 CERTIFICATE (Expiration of notary commission does not invalidate this instrument) I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. 45-5314 es"' ,0 100 y Signed pad sealed at the City of Brookfield, WI this _. _ �� day of 11006.I:t (5-10) Final Waiver of Lien State ofindiana, County of 4 �i SS: being duly sworn that helshe is the�� nine o£Of cer, (11 le) Of I i si "ice mm` leaving contracted with (Contractor) �(Qwner) to furnish certain materials andlor labor as follows: ,�r for a project known as -C) rGl i` (+t` (` fit st'd ,�" �( VIA f U" (lame ofProjeot) located at �rr a s ^ _ 1, and owned by (Owner) and does hereby fanther state on the behalfofthe aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars �........ . . Q receipt of which is hereby acknowledged; or © the payn°aent Of Which has been promised as tho ,sole consideration for this Affidavit said Final Waiver ofLien-vhlch is given solely with respect to said amount, aricl which waiver" shall be cZoctivo only upon rea elpt of paynlent thereof by file undersigned; WAI'l3.I0 that thr 1 oma of e final blalmce clue ffo n cor,dractor isthe st r © xeceipt of which is hereby aclrnowiedged; or ]� the payarient Of wbiclrs has been promised as the sole consideration for this Affidavit and Final Walver° of Lien which shall become eli"ective only upon rccelpt of such payment. THEREFORE, the undersigned waives and releases unto the CJwner° ofsaid premises, any and all liens or claims whatsoever oil the, above-describedproperty and improvements thereon an, accoarut of labor or material or both, furnished b the undersigned tharcto, subject to lianitatlons or conditions expressed herein,, if any, and Iiartlrcr cersifled thatno other party has any claim orri htto a acid Waiver ol'Iofa y p undersigned for said projcct, and wlthlxl the sc pa of this Affidavit iacn on account of any, work performed or material tlrrriisli�d, to the rurdei�l . 12 TAT E DP IDIA&ti y _... ( t p M on e Re resell (atnv+) SS: E-0)l bhj m ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared„.', (.w, and acknowledged the execution of the foregoing Affidavit and Waiver afLion. i Ihavehereunto subscribed name y �� a �./ _,� ... day of 200, � WITNESS �ERL''DI.a grad affixed m official seal on the my Commission Expires: ' - ' Residing in Signature JANEE M I€i7a4ttV `"`"".�' T-INDIANA VotaryPublic Name MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO.710399 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11 /16/2018 Name Toy Villa Department Public Works - .._..................— Division/Bureau Engineering BPW Date 11/27/2018 Phone Extension 5920 .. .... 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 the ro riate Item T ie Requires for All Submissions Agreement Amendment Contract Proposal Addendum um Professional Services Resolution Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet Quote Opening Quote Award [� Change Order No. C/O & PCA No. ® PCA Ease/Encroach. Traffic Control: f IOther: Required Information Company or Vendor Name Premium Concrete Services, Inca Yes Z No If Yes, Approved by New Vendor Purchasing MBE/WBE Contractor ..-.... _.............. .... WB E MBE/WBE Contractor Requested ITIT ITITITITmmITITmmmmm ❑ No Yes Name of Company �ITITmmXYmnMBE Project Name 2018 Curb and Sidewalk Construction - Division B2 . _._ .._� ............. Project Number 118-007 Funding Source .. ........ ................. MVH Account No. ._.._........_ _ .... 202.0619.431.31.06 Amount w .................... $36,160.00 Terms of Contract Purpose/Description ................. ._..._.......... ._....... Project Closeout ............. Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Amount of LJ Increase Decrease Previous Amount $ Current Percent of Change: _ New Amount $ Total Percent of Chanee: Copy Original El ❑ uirl ed For C'ange Orders On Disoemrsal After Kara Boyles, City Engineer ._. ._.._ .. .............- Marcia Qualls