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HomeMy WebLinkAboutProject Completion Affidavit - Morris Theater Mezzanine Handrails Project No 118-081 - Larson Danielson Construction Co Inc1316 COUNTY —CITY BUILDING 227 W.JEFFERSON BOULEVARD SOI ITH BEND_ INDIANA 46601-1 930 ,o1 PACE � a� 186 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS February 26, 2019 Timothy Larson Larson Danielson Construction Co., Inc. 302 Tyler Street LaPorte, IN 46350 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Morris Theater Mezzanine Handrails — Project No, 118-081 Dear Mr. Larson: 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 $23,525. 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'UNDIANA50 BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Morris Theater Mezzanine Handrails PROJECT NO h|118-081 FINAL COST $23525.00 CONTRACT SIGNED PROJECT DESCRIPTION Installation of handrails in the mezzanine at MPAC,12/20/2018 MAINTENANCE AGREEMENT ENDS 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 bysuch contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City ofSouth Bend which were apart ofthe above Contract. Executed thiday of, February 2019 Larson -Danielson Company Name Signature Timothy F. Lar5on, President Company Address Printed Name LaPorte, IN 46350 City, State, Zip VYD?NESSESS: Before mo, the undersigned Notary public in Timothy F. Larson, and acknowledged h7-X�Ojj6��m Notary Sig day of February -, 201 9 U1 rorj�,- — My 679923 Cathy A. Sal,_e Printed Name County ofResidence La Porte ly appeared rnpletion Affidavit on If the Contractor iaacorporation, the following certificate will beexecuted. | Terry ALarson - Timothy F. Larson — who signed this release on behalf of the contractor was then President of said Corporation; that said release was duty signed for and on behalf of said CoFr oja,011,n by�Autfi�-ity of its governing body, and is within the scope of corporate powers,: Terry A. Larson LARSIMMANMAGaWal CONSTRUCTION CO., INC Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project Works that itboordained so. AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of La Porte SS: math F. Larson ,.•. _........ being duly sworn that he/she is the President (Name of Officer) (Title) of %-- ' having contracted with Larson=Danielson Construction Co., Inc. (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: Morris Theater Mezzanine Handrails (Description) for a project known as 211 N. Michigan Street, South Bend, IN 46601 - -----, (Name of Project) located at City of South Bend Indiana Board of Public Works and owned by _ _. ... (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of 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; (FINAL WAIVER) that the final balance due from the contractor is the sum of Fz.gAy ;ml Vie.... ousand. Y9_.. m_ndJgd _,Ty?.nt"!v and �_...0�... Elreceipt of which is hereby acknowledged; or00/100 )A C © the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien whi 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 mai " v'8 on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersi ed thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim c I rio tip lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of dfl Afl2aFm and Waiver of Lien. c-) o ZO n Co., Inc. B i STATE OFINDIAN (Firm)nstructio Y ta�horr'zed Representative) A ) Timothy F. Larson, President LAPORTE ) SS: )�MOXX COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Timothy F . Larson and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. __................. _ _....W__. - IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the 13 th day of ..... bruary...... ­­­)m 2olq_ Notary Publi ignature M Commission Ex ices: February 11, 2024 Y P iCA _ . Residing in La Porte . . County, of ..._. N ary Publ�� � � �, ��:� ��,��9 � Vy A»ir'tit.E p V1 WIrv' 1,� �FI�� sIM d yi rnu�:wssy a fry�x�PdiuVs BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 02/15/2019 Department Public Works Name Toy Villa Division/Bureau Engineering �....... ---- m _ __........_. BPW Date 02/26/2019 Phone Extension 5920 iwimim umuwce,�.re®awnvunmmo,uwrrwmvm�wa!wAwwu!wwwwwwwwwwwwwwwwwwwwuwwwiwwu�nrcwuru nwwwommmmomama�w�mwwu mmmomomomwmm m„wumremmwma . Required Prior to Submittal to Board.. w 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 E] Agreement Amendment Professional Services ❑ Bid Opening ❑ Quote Opening F❑ Change Order No. EI Ease/Encroach. F-1' Other: �ropnate Item Type El Contract Resolution El Bid Award El Quote Award El C/O & PCA No, ❑ Traffic Control, Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description for All Submissions J Proposal w ❑ Req. to Advertise Required Information Addendum ❑ Title Sheet Larson -Danielson Construction Co., Inc. . ............................. [❑ Yes Z No ❑ If Yes„ A py� by Purchasing MBE 0 WBE No Yes Name of mCo an _... �. .. P__ -y�.� �. ........- - .....� Morris Theater Mezzanine Handrails 118-081 Morris Performing Arts Center Capital ..� 101.0404.453.36.01 Project Closeout. ❑ Required Contractor's Certification Forms Attached (Non - Collusion Non -Discrimination, Non -Debarment, E-Verify, Iran„ etc. c uired For Chang Orders Only Amount of Increase $ El Decrease $ Previous Amount $