HomeMy WebLinkAboutProject Completion Affidavit - Four Winds Field Landscaping - Foegley Landscape Inc1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1 930
CITY OF •' BEND PETE BuTTIGIEG, MAYOR
BOARD OF PUBLIC V41MVS
April 23, 2019
John Foegley
Foegley Landscape, Inc.
52215 N. Lilac Road
South Bend, IN 46628
RE: Project Completion Affidavit — Four Winds Field Landscaping
Dear Mr. Foegley:
PHONE 574/235-9251
FAx 574/235-9171
The Board of Public Works, at its meeting held on April 23, 2019, approved the Project
Completion Affidavit for this project in the amount of $32,955.
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 GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Four Winds Field Landscaping
PROJECT NO 1075-2018 FINAL COST $32,955.00
CONTRACT SIGNED Nov. 27th, 2018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Landscaping on first and third baselines outside of Four Winds Field.
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.
q,
Exe ,tdd this _ day of e,,, 201 Foe le Landscape Inc.
Company Name
o'iature � 52215 N. Lilac Rd.
a 'L t I fttitt Company Address
P Int :d Name South Bend, IN 46628
City, State, Zip
W:TNESSESS:
the day of , 201 9
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Not, &&mature My Commission Expires
Us,4 M 140M )Ni u IK
Printed Name County of Residence
If the Conn actor, is a
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Baas
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the following certificate will be executed.
certify that I am Secretary of the Corporation executing this release; that
....................... µµµ_, _ 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!
LL,N__
wemii g body„ gad is within the scope of corporate powers::
_ Corporate Seal
Printed Wnie "h
DEPA TMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so...
Date:
Construction Manager
Gary A. Gil", resident
Therese J. C drau, Merfr6er
BOARD OF PUBLIC WORKS APPROVAL
Genevieve Miller, Member
Laura O'Sullivan. Member
Date: ,41 3 --.�
Meth A. Maradik, Member
nda M. Martin, Clerk
(ZAI-6ZOA, ,
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of 14. L ^lpe SS:
a
W being duly sworn that he/she is the Vreswt
(Name ofOfficer(Title)
of having contracted with 1
(
bcontractor/Supplier) (Contractor)
cc
to famish certain materials and/or labor as follows: "� � � �
(Description)
4-1
for a project known as V V� �V 1
(Name of Project)
located at
and owned by 1'��
(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;
that the Tina ba n e duOVW
e�ftom,�co as or is the sum of� $
❑ 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; and further certified that no other party has any claim or right to a
lien on account of any work performed or material furnished to the undersigned for said project, and within the sco a of this Affidavit
and Waiver of Lien.
n By
C , (Ruth rled R rese i� d
(Fi) ' )
STATE OF 1N IANA
SS:
ST. JOSEPH COUNTY _
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared � n �c„ „ eg
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. p
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official se on the / day of
i �.
Not Public Signature
My Commission Expires:
Residing in - County, Notary Public Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name
04/18/2019
Patrick Sherman
Department VPA
BPW Date 04/23/2019 Phone Extension 5601
➢flfl � 18N' ' 91IIWwwvwml � NNMdN 'N�W@WWMI@IIIIIIII w�ww�IwVIVIVIVIV
_._ ._.W....._ ..... _
Required Prior to Submittal to Board q
Legal ® Attorney Name Clara McDaniels
Controller z 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 Z Michael Schmidt
Check the
Agreement
Professional Services
Bid Opening
�] Quote Opening
Change Order No.
El Ease/Encroach.
F-1 Other:
Egpnate Item Type — Reli
El Contract
❑ Resolution
Bid Award
El Quote Award
El C/O & PCA No.
F Traffic Control
or All Submissions
..
Proposal
❑ Req. to Advertise
Reluired Information
Company or Vendor Name Foegley Landscaping Inc.
Addendum
❑ Title Sheet
New Vendor
❑ Yes ® No ❑ If Yes, Approved by Purchasing
MBE/WBE Contractor
❑ MBE ❑ WBE
MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company
Project Name
Four Winds Field L.... ......
............... andsca�ing �._.......................................................
Project Number
1075-2018
Funding
Funding Source
�ww ............................. _........ ....
Non -reverting Cove fund
Account No.
401-1101-452.36.09
Amount
$ 32,955.00
Terms of Contract
Complete by April St, 2019 __..
Purpose/Description
Project Completion Affidavit
Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.
Required For Cane Orders Only
Amount of Increase $ -
Decrease $
Previous Amount $ 32,955
Current Percent of Change: 0%
New Amount $ 32,955
Total Percent of Change: 0%
Dispersal After Approval
Copy
Original
❑
❑
❑
El
El
El