HomeMy WebLinkAboutProject Completion Affidavit - Bowman Creek Improvements Project No 118-017 - Selge Construction Co Inc1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOI JTH BEND. INDIANA 46601-1 930
1865
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARDU IC WORKS
February 26, 2019
Robert Kuhns
Selge Construction Co., Inc.
2833 S 1Ith Street
Niles, MI 49120
PHONE 574/235-9251
FAx 574/235-9171
RE: Project Completion Affidavit — Bowman Creek Improvements — Project No. 118-017
Dear Mr. Kuhns:
The Board of Public Works, at its meeting held on February 26, 2019, approved the Project
Completion Affidavit for this project in the amount of $98,240.
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
�,MYf 1Yk 7R
CITY OF SOUTH BEND, INDIANA ft,
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT'
PROJECT NAME Bowman Creek Improvements
PROJECT NO 118-017 FINAL COST $98,240.00
CONTRACT SIGNED 6/12/2018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Replacement and cleaning of various culvert entrances on Bowman Creek.
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.
Exeoute r"s day off 201
Signature
Robert Kuhns, Project Engineer
Printed Name
Sel a Construction Co. inc.
Company Name
2833 S 11 th St
Company Address
Niles MI49120
City, State, Zip
WITNESSESS:
Before rne, the undersigned Notary Public in and for said country and state, personally appeared
Robert.Kuhns z and acknowledged his/her signature to the above Project Completion Affidavit on
the 10t-hday f.,_�TaI1L7�L�7 201 9 rrrr�rrxa����*
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ary Igndture My Commission Expires ai 2 2020.
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Pri ted Name icki A.Pr1eSt Count of Residence Berrien
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' If the Contractor s a �e corporation, ccorporation, the following certificate
7.25-2020
I am Secretary of the Corporation executing this rel
__
Robert Kubnswho signed this release on behalf of the contractor was theIN .....'
ineev of said Corporation; that said release was duly signed for and on behalf of said
Corporation by A orky of its governing body, and is within the scope of corporate powers:
Secretary"s ignature Corporate Seal
Vi ki A Priest
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for f` al approval and we recommend to the Board of Public Works that it be ordained so.
Date: t
Construction tiger
Gary A. Gilot, President
Therese J. Dotau, Member
BOARD OF PUBLIC WORKS APPROVAL
Suza
Me
Date: I C 7
eth A. Mar°adik, Member
M. Martin, Clerk
Final Waiver of Lien
State of Indiana, as
WHEREAS, the undersigned Selge Construction Co. lnc,, has been heretofore employed
by the Cmt of Soutli Bend, IN to furnish certain material and labor, to wit: Bowman Creek
linmovements, Project No. 1.1 -017 for the real estate owned by the City of South Bend located
in South Bend, IN County of St. Joseph,
State of Indiana,
Now Therefore, Know Ye, That the undersigned, for and in consideration of Seven Thousand
Sixty Three Dollars and Seventy Five Cents 7 03,7 the receipt of which is hereby
acknowledged, hereby and now waives and releases unto the said owner of said premises, any
and all lien, right of lien or claim of whatsoever kind of character on the above described real
estate. TO AND FOR SAID AMOUNT, an account of any and all labor material, or both
furnished for or incorporated into said real estate by the undersigned up to this date, and we
further certify that the consideration moving to the undersigned for executing this Final Waiver
of Lien has been mutually given and accepted as final payment to or on account of the said
project for said real estate.
Signed, sealed and delivered this 30th day of January, 2019.
Signed
m
Robert Kuhns, Project Engineer
Personally appeared before me this 30th day of January, 2019, Robert Kuhns, who, being duly
sworn on oath, says: That he is Project 1 ��g'��eer of the Sel � C ��strc�cti�an. C;'o. Inc, and that he
hereby acknowledges the execution of the foregoing instrument for and on behalf of said Selg_e
Construction Co. Inc.
, J . rs,
My Commission expires: 0712 5/202t1
Notary Public�R
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PUBLIC
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25 2020
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BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 02/07/2019 Department Public Works
Name Toy WillDivision/Bureau Engineering
BPW Date 02/26/2019 Phone Extension 5920
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e ie nor o u mitta to Board
Prior to SubrNi--- I �to Board
Legal E] 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 0
Check the
E] Agreement Amendment
F] Professional Services
Bid Opening
Quote Opening
E] Change Order No.
E] Ease/Encroach.
F-1 Other:
lropriate Item,Type
Contract
F-1 Resolution
E] Bid Award
El Quote Award
0 C/O & PCA No.
El Traffic Control:
Company or Vendor Name
New Vendor
MBEIWBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of increase
Decrease
Previous Amount $
Current Percent of Change:
New Amount $
Total Percent of Change:
Copy
Original
F-1
F1
1-1
1:1
El
1:1
for AH Submissions
Proposal
E] Req. to Advertise
ired Information
Selqe Construction Co., Inc.
Bowman Creek Improvements
118-017
Sewer Contractual
641.0621.792.63.35
$98,240.00
Protect Closeout
Addendum
D Title Sheet
[:1 Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination , Non Debarment, E-Verify, Iran, etc.
o�ed For Change Only
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Dispersal After Armroval