HomeMy WebLinkAboutProject Completion Affidavit - College and Sunnymede Ave Traffic Calming Solar Radar Speed Display Signs Project No 117-113A - Pemberton Davis Electric Inc1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND_ INDIANA 46601-1 830
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
i1A"1 OF PUBLICWORKS
January 22, 2019
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 — College and Sunnymede Ave. Traffic Calming
Solar Radar Speed Display Signs — Project No. I I7-113A
Dear Mr. Ferro:
The Board of Public Works, at its meeting held on January 22, 2019, approved the
Project Completion Affidavit for this project in the amount of $25,420.
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 LAURA O'SULLIVAN THERESE J.
DORAU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS W
PROJECT COMPLETION AFFIDAVITn
PROJECT NAME Solar Radar S eed Dis Ia Si ns Div.A-C
PROJECT NO 117-113A FINAL COST $25,420.00
.....................
CONTRACT SIGNED 12/21/2017 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Install traffic calming devices at two (2) locations, all within the City 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 d this 2a� day of - 201 Pemberton Davis Electric Inc.
�.._.
any Name
'Ay"
916 E. McKinkey Ave.
Company Address
ciAm
Printed Name Mishawaka, IN 46545
City, State., Zip
WITNESSES&
Before me, the undersigned Notary Public in and for said country and state, personally appeared
J0—W,J A. rel2 , and acknowledged his/her signature to the above Project Completion Affidavit on
the '2drW day of ,tr 201 u
�
Notary tignature My Commission Expires
Printed Name County of Residence 5TriJ
I y, certificate orporationthe following will be executed.
f the ontr otoJL r is acertify 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 key '76ty o s governing body, and is within the scope of corporate powers:
Secretary's S' nature
Corporate Seal
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable f f I approval and we recommend to the Board of Public Works that it be ordained so.
P 1
Date:
Construotw . nag,er
BOARD OF PUBLIC WORKS APPROVAL Date: r;�ra �/�
Gary A. GI? " resident St ina M. Fritzbt r Member Elizabeth A. Maradik, Member
Therese J orau, Member , Member I it a M. Martin, Clerk
Final Waiver of Lien
State of Indiana, County of . i°� SS:
�LA9 A.,�~�� being duly sworn that he/she is the
(Name of Officer) (Title)
of �� 2 /g aving contracted with Gi TY 0 'S tom, /O 6
(Contractor) (Owner)
to furnish certain materials and/or labor as follows;
m....._... (Description)
for a project known as Sc '✓ ,e 1� P , c 4:5/.6�? �
(Name of Project)
located at OF
and owned by
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the suns of
Dollars ($ )
❑ receipt of which is hereby aclmowledged; 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 payinent thereof by the
undersigned;
(FINAL WAIVER that the final balance due e s of
rw � � m the contrAL
ry—
❑ receipt of which is hereby aalmowledged; 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.
" 1113REFORE, the undersigned waives and releases unto the Owner ofsald pronAlses) any anti all liens or claims whatsoever
on the above -described property and improvements thereon an accowit of labor or material or both, Runished b the trtwderslgned
thereto, subject to limitations or conditions expressed herein, if any; and further ortified that no other party has any claim or right to a
lien on account of any work perfornwed or material Aintished to the undersigned for said project; and within the scope of this Affidavit
and Waiver of Lien.
l
(Finn) on ed Representative)
STATE OF INDIANA )
SS:
ST. JOSEPH COUNTY )
Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared i ot•(n( A, t Rj2v
and acicnowledged the execution of the foregoing Affidavit and Waiver of Lien,
IN WITNESS WBEREOF, I have hereunto subscribed ttty name and affixed my official seat on the Zo 7"" day of
Notary Public Signature
My Commission Expires:�z zo
Residing in 57- � _m. County, etl r Notary Public Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 01/02/2019 Department Engineering
Name Toy Villa Division/Bureau DPW
f� ...............
BPW Date 01/22/2019 Phone Extension 5920
NM0NN9MffffWM19fflMMMMMMMMMM
— — — ------------- — - Required Prior to Submittal to Board
Legal F-1 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 AppIq _' riate Item Type, —.Required for All Submissions
Agreement El Contract El Pro p—os"a u m
El Professional Services 0 Resolution
F-1 Bid Opening El Bid Award Req. to Advertise El Title Sheet
E] Quote Opening El Quote Award
El Change Order No. C/O & PCA No. PCA
0 Ease/Encroach. Traffic Control:
H Other:
Required Information
.......... ------- -
Company or Vendor Name
Pemberton Davis Electric
New Vendor
........ A �oyqq by
Yes- . . . . ....... . ... . .. .... . . . ....
�Z_N� F-1 If Ye
MBEIWBE Contractor
.
MBE 0 WBE _ _§i _Tp
MBE/WBE Contractor Requested
11-0, 4 b—ompan . .....
College Avenue & Sunnymede Avenue Traffic Calming - Solar
Project Name
Radar Speed Dis Ip ay Suns
Project Number
117-113A
Funding Source
LRSA
Account No.
. . . . ........... — -- -------_,
— -
251.0608.431.42.96
Amount
..t25,420.00 . ....... . ....
Terms of Contract
Purpose/Description
Project Closeout . . ........
[:] Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.
squired For Chancie Orders Onlv
Amount of increase
Decrease
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Chanae:
Dispersal After A
Copy
Original
F�
El
F�
El
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El