HomeMy WebLinkAboutProject Completion Affidavit - Bendix Theater Handrails at Century Center - Project No 118-036A1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOI )TH BEND. INDIANA 46601-1830
CITY OF OBEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC
February 12, 2019
Marita Kreps
Brown & Brown General Contractors, Inc.
124 S. Elkhart Street
Wakarusa, IN 46573
PHONE 574/235-9251
FAx 574/235-9171
RE: Project Completion Affidavit — Bendix Theater Handrails at Century Center — Project
No. 118-036A
Dear Ms. Kreps:
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 $12,915.
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,
IL
Linda M. Martin, Clerk
Enclosure
GARY A. G1LOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK LAURA O'SULLIVAN THERESE J. DORAU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT 1 10,
PROJECT NAME Bendix Theater Handrails at the Centua-!Center
PROJECT NO I I 8036A FINAL COST $12,91�5.00�����
CONTRACT SIGNED 7/24/2018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Install handrails at the Bandix Theater.
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.
O'cu d this 9 Brown & Brown General Contractors, Inc.
Company Name
Signature 124 S. Elkhart Street
Marital Kreps Company Address
Printed Name Wakarusa, IN 46573
City, State, Zip
WITNESSESS:
Before me, the undersigned Notary Public in and for said country and state, personally 0 Todd A Marek
Marita Kreps —,and acknowledged his/her signature to the above Project Coi ripletion Affida*ibt" Public
the 15th day of January , 201 9 SEAL
Marshall County, State of Indiana
/,,7 My Commission Expires April 3, 2025
C ' i
Notary Signature My Commission Expires 4/34Q26--!4=s"on Number; 698752,
Todd A. Marek
Printed Name
County of Residence Marshall Co., IN
If the Contractor is a corporation, the following certificate will be executed.
i, .... Hannah " M. Aitken certify that I am Secretary of the Corporation executing this release; that
_Morita Kreps who signed this release on behalf of the contractor was then
Vice -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:
11A.4 11 A, 64-0 J442jc�--
Sec4—far_y's Signature Corporate Seal
Hannah M. Aitken
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acoeptabi forTTI approval and we recommend to the Board of Public Works that it be ordained so.
------T' 7J, 1 / 1
Date: 1-
(;onstructio nager BOARD 9F PUBLIC WORKS 7 d AAP OVAL Date:
r
Elizabeth A. Maradik, Member
Gary A. Gilot , resident Suzann� M. Fritzbeig,-MeTifir
Therese J. Dorau, Member ",- LauWO'Sulllvan, MoRber Linda M. Martin, Clerk
FFIDAVIT AND WAIVER OF LIEN
State of Indiana County Elkhart
rt SS:
ww_
Marital Kreps __m.. being duly sworn that he/she is the Vice -President _
(Name of Officer) (Title)
of Brown & Brown General Contractors, InRaving contracted with
�Subcontr4ictor/Supplier;)
to furnish certain materials and/or labor as follows: Handrails
for a project known as
located at
and owned by
Bendix Theater
Century Center
City of South Bend, IN
City of South Bend, IN
(Description)
(Name of Project)
(Owner)
and does hereby fiuther state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
(Contractor)
Dollars_
❑ 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,
Twelve thousand nine hundred fl�"teen and/1�b� um of
ITM�.. IT o ontractor is the s �2 915.00
AL WAIVER) that the final ba ce due f
® 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; mid further certified thatno other party has any claim or right to a
lien on account of any work perforated or material rurnished to the undersigned for said project, and within the scope of this Affidavit
and Waiver of Lien.
r
n eneraontractors, Inc."
Brown & Brown General CBy
(Firm) I-L4e�(q—At,
.. llepresentative).aa.�
STATE OF INDIANA )
) SS:
=*080W,9Xq)" Elkhart )
Before me, the undersigned„ a, Notary Public, in and for said County and State, personally appeared Marita Kreps
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN
-... day of
Janua 200y affixed my official seal on the 15tht
WITNESS WHEREOF, I have hereunto subscribed m naameme and
Notary Public Sgnature
My Commission Expires: 4/3/2025
..........................................
Indiana ToddAMarek`Not:
Residing in shall _ 1 County, �,
Marshall
.., . o. _.„...._,�..�gotary Public
SEAL
Marshall County, State of Indiana
My Commission Expires April 3, 2025
C�)mrnfsslan Number, 698752
Marek
ME
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 01/18/2019 Department Public Works
Name Toy Villa Division/Bureau Engineering
BPW Date 02/12/2019 ....� w�.�... _......._ ...�.e..... .........
Phone Extension 5920
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Ieuired Prior to Submittal to Board
Legal ❑ Attorney Name:
Controller El 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
Checkthe
Agreement Amendment
El Professional Services
Bid Opening
Quote Opening
El Change Order No.
Ease/Encroach.
Other:
Company or Vendor Name
)rq riate Item Tyke —
Contract
Resolution
l Bid Award
❑ Quote Award
❑ C/O & PCA No.
❑ Traffic Control:
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of I � Increase
F] Decrease
Previous Amount $
.................
Current Percent of Change:
New Amount$
Total Percent of Chanee:
Copy
Original
❑
❑
El
❑
]
❑
for All Submissions
Proposal
❑ Req. to Advertise
uired Information
Brown & Brown General Contractors„ Inc.
Proiect Closeout
Addendum
❑ Title Sheet
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non-Discrimination, Non -Debarment, E Verif ,Iran etc.
;,-nuired For Change Orders�Onl
Disoers�
al After ADDroval