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HomeMy WebLinkAboutProject Completion Affidavit - Rum Village Dog Park Construction - R Yoder Construction Inc1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOI JTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYA9' BOARD OF PUBLIC WORKS I December 11, 2018 Jason Yoder R. Yoder Construction, Inc. 27453 CR 150 Nappanee, IN 46550 RE: Project Completion Affidavit — Rum Village Dog Park Construction Dear Mr. Yoder: PHONE 574/ 235-9251 FAx 574/ 235-9171 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 $143,257.3 1. 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 PROJECT NAME 2018 Rum Village Dog Park Construction PROJECT NO 1060-2018 FINAL COST $143, 57,31 CONTRACT SIGNED 6/12/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Installation of a Dog Park at Rum Village Park vvI 111 = 1 ri. #NAME? 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 abo,v✓e1 Contract. Exealisday of "7 i o VP�yyi I� 201� R. Yoder Construction i�� i Company Name ture gna27453 CR 150 Randy Yoder Company Address Printed Name Na an IN 46550 PATRICIA KAY KAYLOR ....� Notary Public- Seal City, Sta ro Zip WITNESS SS: State of Indiana My Commission Expires Nov 20, 2020 t .5.�" day of 201. Notary Signature My Commission Expires November 20, 2020 Patricia Kay K2 for Printed Name County of Residence Elkhart If the Contractor is a corporation, the following certificate will be executed. I, Be h Yoder , certify that I am Secretary of the Corporation executing this release; that Randy Yoder who signed this release on behalf of the contractor was then President of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of Its governing body, and is within the scope of corporate powers: Secretary's Sibnature Corporate Seal Beth Yoder Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project 1 . G pt ble for final approval and we recommend to the Board of Public Works that it be ordained so. 11X1 Date: 12 Construction Manager BOARD OF PUBLIC WORKS APPROVAL Date: ,b/ Gary A. Gilot, President Suzanna M. Fritzberg, Member Elizabeth A. Maradik, Member , James A. Mueller, Member M. Martin, www ryoderconstruction com R. YODER CONSTRUCTION, INC. .m _ .... v.., �,....._..w. _�. _ ..._�_.. _�., w....n� __..,.,� a*W 1978 Tel: 574.773,3502 . Fax: 574.773.4941 27453 CR 150 . P.O. Box 69 Nappanee, IN 46550 AFFIDAVIT, RELEASE AND WAIVER OF LIEN ❑ Partial El Final Fi Payment to Follow On this date of November 1st 2018 in the State of Indiana, County of Elkhart Randall E. Yoder being duly sworn, states that he is President of R. Yoder Construction, Inc. having contracted with City of South Bend to furnish certain materials and/or labor for the project known as Rum Village Dog Park located at 2626 S Gertrude St, South Bend, IN 46614 and owned by City of South Bend for the total amount of contract including extras is $ 143,257.31 of which R. Yoder Construction, Inc. has received payment of $ 128,931.58 prior to this payment. And does hereby further state on behalf of R. Yoder Construction, Inc; AFFIDAVIT ❑ PARTIAL WAIVER There is due from Owner the sum of: Dollars $ ❑ Receipt of which is hereby acknowledged (unconditional); or ❑ The payment of which has been promised as the sole consideration of this Affidavit, Release and Partial Waiver of Lien which is given solely with respect to said amount and is effective upon receipt of such payment (conditional); El FINAL WAIVER The final balance due from Owner is the sum of: Fourteen Thousand Three Hundred Twenty Five Dollars and Seventy Three Cents Dollars $ 14,325.73 ❑ Receipt of which is hereby acknowledged (unconditional); or [D The payment of which has been promised as the sole consideration of this Affidavit, Release and Final Waiver of Lien which shall become effective upon receipt of such payment (conditional). 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 on account of labor, material and/or services provided by the undersigned, subject to the limitations or conditions expressed herein, if any; and further releases claims of any nature against the Owner. The undersigned further certifies that all parties who have provided labor, materials and/or services for said work have been fully paid, or will be fully paid out of the payment contemplated herein, if any, such that no other party has or shall have any claim or right to a lien on account of labor, materials and/or services provided to the undersigned for said project and within the scope of this Affidavit, Release and Waiver of Lien. I SWEAR OR AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE F REGOING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE. R. Yoder Construction, Inc President (Company Name) ( epre n rre Signature) (Title, please print) fore me this 1 St day of November 2018 (Day) (Month) (Year) 71v" PATRICIA KAY KAYLOR Patricia Kay4ylor Notary Public- Seal November 20, 2020 State of Indiana (Printed Name) My Commission Expires Nov 20, 2020 (My Commission Expires) BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 12/06/2018 Patrick Sherman Department VPA BPW Date 12/11/2018 Phone Extension 5601 mmwmmmmm�mmimimimmmmmmuiuwwmim: wwrwmarm wtmrwuumr mmr�w�mmnmmmmmnmmlw m= �mRcquired Prior to Submittal to Board Legal ® Attorney Name Clara McDaniels Controller ® Controller review is required for all Contracts $5,000.00 or more anc greater than one year in length per the City Purchasing Policy Purchasing ® Michael Schmidt Check the LJ Agreement [] Professional Services ❑ Bid Opening ❑ Quote Opening Change Order No. _ �] Ease/Encroach. ❑] Other: ro riate wItem Type — Contract Resolution Bid Award E, Quote Award �! C/O & PCA No. _ Traffic Control for All Submissions .w ITIT ._. Addendum � Proposal ❑ Req. to Advertise ❑ Title Sheet Required Information Company or Vendor Name R. Yoder Construction /1 ' New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBE/WBE Contractor Requested [:1 No ❑ Yes Name of Company Project Name Rum Village Doi Park Construction Project Number 1060-2018 Funding Source 2015 Park Bond Account No. 751-1101-452-39.89 Amount �.. w_.......-.-.m-.. _m .............. ��������A... .. $ 143,257.31 Terms of Contract ... Purpose/Description P__.............mw. ro ect Closeout Required Contractor's Certification Form Attached (Non- .... _ ..... Collusion, Non -Discrimination, Non -Debarment, -Verify, Iran, etc. Required For Change Orders Only Amount of El Increase $ [❑ Decrease $ Previous Amount $ Current Percent of Change: New Amount $ Total Percent of Change: Copy Original F-1 El ❑ El E] F] Dispersal After Approval ........................