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Home My WebLink AboutProject Completion Affidavit - 2016 Downtown Parking Garage Improvements Project No 115-143 - Gibson Lewis LLC1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOI ITH BEND. INDIANA 46601-1 830 Robert Lingenfelter Gibson -Lewis, LLC 1001 West I Ph Street Mishawaka, IN 46544 M CY, 1865 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYCM BOARD OF PUBLICWORKS February 12, 2019 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — 2016 Downtown Parking Garage Improvements — Project No. 115-143 Dear Mr. Lingenfelter: The Board of Public Works, at its meeting held on February 12, 2019, approved the Project Completion Affidavit for this project in the amount of $1,228,684. 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 PROJECT COMPLETION AFFIDAVIT PROJECT NAME 2016 Downtown Partcin Garage Improvements PROJECT NO 115-143 FINAL COST $1,228,684.00 CONTRACT SIGNED 11/22/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Improve all elevators at Leiqhton and Wayne Street aaraaes. JWT1k1i I*1-V: M 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, Isis 10th day of JailUary 201 Gibson -Lewis LLC Company Name Signature 1001 West 11th Street Robert A.-Lingenfelter, President Company Address Printed Name Mishawaka, IN 46544 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared obe t. A. iD,ggDf_e d acknowledged his/her signature to the above Project Completion Affidavit on the/ °" day of JanU� 201 , Notary Signature My Commission Expires Elizabeth A. Biddle Printed Name County of Residence July 10, 2024 St. Joseph If the Contractor is a corporation, the following certificate will be executed. 1, certify 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 by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name Corporate Seal DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for Itn 1 approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction er BOARD OF RUBLIC WORKS APPROVAL Date: F Gary A. Gitot„'" resident a a r�tzberg„ m er Elizabeth A. Maradik, Member Therese J. Dorau, Member ',--Laura O'Suttiva ber L(nda M. Martin. Clerk WHEREAS, said contract provides that the Principal will furnish a bond conditioned to guarantee for the period of three ( 3 ) year(s) after approval of the final estimate on said job, by the owner, against all defects in workmanship and materials which may become apparent during said period, and WHEREAS, the said contract has been completed, and was approved on m,,.... „. December 20 2018 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that, if the Principal shall indemnify the Obligee for all loss that the Obligee may sustain by reason of any defective materials or workmanship which become apparent during the period of three ( 3 ) year(s) from and after.. -December 20 2018 then this obligation shall be void, otherwise to remain in full force and effect. SIGNED, SEALED AND DATED this Form F4591 10th day of January 2019 m......... .. .. ............., ........... 111"'..... Gibson -Lewis, LLC (Principal) BY __....-- .............. .-_ Seal _ (Seal) Robert A. Lingenfelter, President The Continental Insurance Company --- ............ (Surety) By , _ - : — eal)� tre 'a R. S Ott, �✓ latte rney-in-Fact ACKNOWLEDGMENT OF SURETY STATE OF MICHIGAN ) COUNTY OF OAKLAND ) On this loth day' January 2019, before me personally came Latrecia R. Scott w1io, being by me duly sworn, did depose and say that she is an Attorney -in -Fact of the Continental Insurance Company and knows the corporate seal thereof, that the seal affixed to said annexed instrument is such corporate seal, and was thereto affixed by authority of the Power of Attorney of said Company, of which a Certified Copy is hereto attached, and that she signed said instrument as an Attorney - in -Fact of said Company by like authority. Acknowledged and Sworn to before me on the date above written My Commission Expires Jamie M Laurencelle Notary Public, Oakland County, Michigan My Commission Expires: February 2, 2024 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That The Continental Insurance Company, a Pennsylvania insurance company, is a duly organized and existing insurance company having its principal office in the City of Chicago, and State of Illinois, and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint Latrecia R. Scott , Individually of Southfield, MI , its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature — In Unlimited Amounts — Surety Bond Number: 929641294M Principal: Gibson -Lewis, LLC Obligee: City of South Bend Board of Public Works and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the insurance company and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Board of Directors of the insurance company. In Witness Whereof, The Continental Insurance Company has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 3rd day of June, 2015. The Continental Insurance Company . nt State of South Dakota, County of Minnehaha, ss: On this 3rd day of June, 2015, before me personally came Paul T. Bruflat to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of The Continental Insurance Company, a Pennsylvania insurance company, described in and which executed the above instrument; that he knows the seal of said insurance company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said insurance company and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance company. ,' . 1EICH W NOTARY PUBLIC I uTlt OAXOTA ' M Commission Expires February 12, 2021 S, I:icu._.._.- W WW. Notary Public Y P Y CERTIFICATE I, D. Bult, Assistant Secretary of The Continental Insurance Company, a Pennsylvania insurance company, do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance company printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance company this 10th day of January 2019 �Mr The Continental Insurance Company S . re 5 D. Butt 1 M M Fomk F6850-4-2012 ® Final State of Indiana, County of St. Joseph, SS Randall H. Rice ISA Form #1 - 402 PREPARE IN CUPLICATE Original - Contractor AFFIDAVIT AND WAIVER OF LIEN Duplicate - Subcontrator ❑ Partial ® Payment to Follow being duly sworn states that (s)he is the Asst. Secretary of (Name of Officer) (rille) Gibson -Lewis, LLC having contracted with CITY OF SO. BEND BRD OF PUBLIC to furnish certain (Subconlraclor/Supplier) (Contractor) materials and/or labor as follows General Construction ( escription for a project known as SB PARKING GARAGE IMPROVEMENTS located at SOUTH BEND, IN and owned by and does hereby further state on behalf of the aforementioned subcontractor/supplier: 6akfmti�Slf�CAz1 ' a4t tttfl�s a [ ] receipt of which is hereby acknowledged; or CITY OF SOUTH BEND Dollars ( (Owner) [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given soley 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 One hundred twenty-two thousand eight hundred sixty-eight and 47 / 100 Dollars ( $ 122,868.47 ) [ ] receipt of which is hereby acknowledged; or [ X] the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above -described property and improvements there on on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions rases herein, if any; and furthre certifies that no other party has any claim or right to a lien on account of any work rfo tried or terb P tturn ed to the undersigned for said project, and within the scope of this affidavit and waiver. Gibson -Lewis, LLC By Title Asst. Secretary (Authorized Representative) WITNESS MY HAND AND NOTARIAL SEAL, this 10th day of January 2019 .I (Notary Public) My Commission Expires: July 10, 2024 Printed Elizabeth A. Biddle Residing in St. Joseph County „"„;`" ELIZABETH A. BINDLE' 41 Notary Public, State of Indiana SEAL L' :. St. Joseph County r i.•�t My Commission of f ......... July 10, 2024 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 01 /18/2019 Department Public Works Name Toy Villa Division/Bureau Engineering ....... ._..... _.w.... _... ..... BPW Date 02/12/2019 Phone Extension 5920 uuummmmmMM111um... ivwwrm�m oouommioio�uiuiuimmmuiuumm e.... r�aa r ��o ormn��auwrmr rr�uw.wuu v�ercam esuired 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 Appropriate Item Type Required for All Submissions Agreement El Contract 71 Proposal ❑ Addendum [J Professional Services El Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening El Quote Award El Change Order No. R C/O & PCA No. ® PCA Ease/Encroach. El Traffic Control: F-1 Other: Rggyired Information Company or Vendor Name Gibson -Lewis,, LLC �........ n Yes M No ❑ If Yes, Approved by New Vendor rc asin� ....__._._ B� MBE/WBE Contractor MBE/WBE Contractor Requested ❑ No ❑Yes Name of go_ mpa t � Project Name 2016 Parking Garage Improvements Project Number 115-143 Funding Source Major Moves ................... Account No. 412.0401.415.36.01 Amount $1,228,684.00 Terms of Contract Purpose/Description Project Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination,. Non -Debarment, E-Verify, Iran, etc. Required For Change Orders Onk _... Amount of EJ Increase w $ Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Disoersal After Copy Original ❑ ❑ ❑ ❑