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Home My WebLink AboutProject Completion Affidavit - Lime Bike Parking Areas Project No 118-059R - The Airmarking Co1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SO[ ITH BEND. INDIANA 46601-1830 CITY OF • BEND PETE i, BOARD D i December 11, 2018 Greg Lowe The Airmarking Co., Inc. 1544 N. SR 25, PO Box 526 Rochester, IN 46975 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Lime Bike Parking Areas — Project No. 118-059R Dear Mr. Lowe: The Board of Public Works, at its meeting held on December 11, 2018, approved the Project Completion Affidavit for this project in the amount of $9,800. 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, 1.-i 6...t ".,� ,. 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 " PROJECT NAME Lime Bike Parking Areas PROJECT NO 118-059R FINAL COST $9,800.00 CONTRACT SIGNED 10/9/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Stri a three 3 Lime Bike arkin areas at various locations. WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Exeoul his ay of XOV EM (3E R 201�. The Airmarkin Co. Inc. Company Name ., ! Signature 1544 N. SR 25, P.O. Box 526 OE Company Address Printed Name Rochester„ IN 46975 City, State, Zip WITNESSESS: e'f re e„ ttbe undersigned Notary Public in and for said country and state, personally appeared .Of�__,, and acknowledged his/her signature to the above Project Completion Affidavit on SH day of A6" 1 n , 201$....._�• Notary Signature My Commission Expires Pe NINN L PIKE Printed Name County of Residence 11` 4 1 If the Contractor is a �co„rporation, the following certificate will be executed. I, _ �.. B' t L _ , certify that I am Secretary of the Corporation executing this release; that L)L.) E 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 Authori of its srvern rag body, and is within the scope of corporate powers: Secrets s Sign re Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for "'r approval and we recommend to the Board of Public Works that it be ordained so. "» .. Date: Construction ger lk"l—BOARD OF PUBLIC WORKS APPROVAL Date: -24t, 0-0 f Gary A. Gilot, Pre adent Suzanna M. Fritzberg, Member Elizabeth A. "Maradik, Member Therese J o�rau. Member James A. Mueller, Member M. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of t^ SS: (Name�of Officer) "being duly sworn that he/she is the _� E� mw (Title) of �...._ having contracted with ��.. (�....�C U t�C . J (Subcontractor/Supplier) (Contractor) to furnish furnish certain materials and/or labor as follows: S R C /� (Description) for a project known as E?14....._ �l -6 5 9 !p p 1 I (Name of Project) ,, I located at C and owned byt�_ (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of ._�....... _........ Dollars .A � �? ..� _..... —.._ ...... ❑ 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 the sum of 4AA - ❑ 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 become effective only upon receipt of such payment. THEREFORE, the undersigned 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 herein, if any; and further 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 s, id project, an within the scope of this Affidavit and Waiver of Lien. _ �_Ati? f 9 G-C r I ... By _.... - ((Firm) Authorize Representativee ) STATE OF INDIANA ) SS: ST, JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared G f3 E /_Q LJ E and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the { day of Notary �,SCaturP My Commission Expires. �. �r� �, �E � � � �E g tY C' �d _.._ _ --Not ,`�4.. L e Residing m 1 Coun BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/03/2018 Department Public Works Name Toy Villa Division/Bureau Engineering ........�nn� BPW Date 12/11/18 Phone Extension 5920 remwm� NNorm �w�wwwww!w!wwwwwuw!wwwwumwuuud�m�dre�anw umhwu�wa�aomamomom�ommmu.mm�umm ..�. �y 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 El Check the Agreement Amendment ❑ Professional Services ❑ Bid Opening Quote Opening Change Order No. Ease/Encroach. [-� Other: Rate Item wT�p f Contract Resolution Bid Award ❑ Quote Award ❑ C/O & PCA No. ❑ Traffic Control: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description for All Submissions Proposal ❑ Req. to Advertise Required Information The Airmarking Co ,Inc. El Yes No _......... ❑ If Yes ._ ........ MBE ❑ WBE No [:1 Yes Name of Co m awn .. Bike Parkin se.��-.�..........._� m. 118-059R Complete Streets Transportation 404.1001.460.42.03 .._. .................. ....._______ $9,800 Proiect Closeout Addendum ❑ Title Sheet IF ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Veri r, Iran, etc. � uilred For Change Orders Only Amount of El Increase $ ❑ Decrease $ .................................... Previous Amount $ Current Percent of Changer New Amount $ Total Percent of Chanae: _.........._... Dispersal After Approval Copy Original ❑ E]