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Home My WebLink AboutProject Completion Affidavit - Fire Station No 4 Project No 116-066 - Gibson Lewis LLC1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOIITH BEND_ INDIANA 46601-1930 Robert Lingenfelter Gibson -Lewis LLC 1001 West 111h Street Mishawaka, IN 46544 tllt'r5 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDU LIC WORKS May 14, 2019 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Fire Station No. 4 — Project No. 116-066 Dear Mr. Lingenfelter: The Board of Public Works, at its meeting held on May 14, 2019, approved the Project Completion Affidavit for this project in the amount of $3,351,062. 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 C1 r"4 Enclosure GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU w�,�crsi u'�r drMw� � CITY OF SOUTH BEND, INDIANA�, BOARD OF PUBLIC WORKS.°°�' PROJECT COMPLETION AFFIDAVIT PROJECT NAME Fire Station #4 PROJECT NO 116-066 FINAL COST $3,351,062.00 CONTRACT SIGNED 12/22/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Tear down and rebuild of Fire Station #4 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. Execs �Iisth day of February „ 201 9 Signature Robert A. Lin enfelter, President Printed Name Gibson -Lewis, LLC Company Name 1001 West 11th Street Company Address Mishawaka, IN 46544 City, State, Zip WITNESSES& Before me„ the undersigned Notary Public in and for said country and state, personally appeared Robert A: -. L �n enfelter , and acknowledged his/her signature to the above Project Completion Affidavit on the day of February Notary r9 �...,.� eau, nature My Commission Expires July 10, 2024 Elizabeth A: Biddle Printed Name County of Residence St. 'Joseph If the Contractor is a corporation, the following certificate will be executed. I, 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 Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This protect is acceptable forofln pproval and we recommend to the Board of Public Works that it be ordained so. Date: t Construction er Gary A. Gilot, President Therese J. Dorau, Member BOARD OF PUBLIC WORKS APPROVAL a yr�c r ember L u a O"Suwva , em r Date: Elizabeth A, Maradik, Member Linda M. Martin, Clerk ,' „.4 1 11 MAINTENANCE BOND Bond No.: 929641300M KNOWN ALL BY THESE PRESENTS: That we Gibson -Lewis, LLC as Principal, and The Continent11 al Insurance Company a corporation organized and existing under the Laws of the State of Pennsylvania as Surety, are held and firmly bound unto City of South Bend, Indiana - Board of Public Works , as Obligee, in the total sum of Three Hundred Thirty-five Thousand One Hundred Six And 20/100 U.S. Dollars jointly and 5,106.20 ) for the payment whereof said Principal and Surety bind ( j y severally, as provided herein. WHEREAS, the Principal entered into a contract with the Obligee dated 12/22/2016 for City of South Bend - Fire Station #4 Project #116-066 ("Work"), NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall maintain and remedy said Work free from defects in materials and workmanship for a period of 3 year(s) commencing on 6/22/2018 (the "Maintenance Period"), then this obligation shall be void; otherwise it shall remain in full force and effect. PROVIDED, HOWEVER, that any suit under this bond shall be commenced no later than one (1) year from the expiration date of the Maintenance Period; provided, however, that if this limitation is prohibited by any law controlling the construction hereof, such limitation shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by such law, and said period of limitation shall be deemed to have accrued and shall commence to run on the expiration date of the Maintenance Period. SIGNED this 7th day of February 2019 (Principal) Gibson -Lewis,. LLC By. _�_ Robert A. Lingenfelter, President e lie Continentat It tirance Compaq y. Latrecia R Soo? , ttcrney-in_ act ACKNOWLEDGMENT OF SURETY STATE OF MICHIGAN ) COUNTY OF OAKLAND ) On this 1k, day of -�. 2019, before me personally came who, being by me duly sworn, did depose and say that she is an Attorney -in -Fact of the 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 Kathy DelGreco Notary Public, Oakland County, Michigan My Commission Expires: September 3, 2020 ..... ._... .......... ._. . ( rrtrrr) ,hib4c) 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 — Surely Bond Number: 929641300M Principal: Gibson -Lewis, LLC Obligee: City of South Bend, Indiana - 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 Comp I any ,*, ;� ra Paul 'i µ Bruflat ice President 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 sworn, 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. ♦r�r....«.«`�r*,rrrrrrwwr~w,�. rr I rt A I l �c $ fr•rrrrrrrrrr+rvr�wwvrrr I aau�tSOUTHDArmpra My Co I mmission Expires February 12, 2021 S. Eich Notary Public 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 certi fy 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 7th day of February 2019 S• The Continental Insurance Company � M i 4 '.: D. Bult _...._ ..._. _.. Assistant e.creiary ... AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of St. Joseph SS: Robert A. Lingenfelter being duly sworn that he/she is the President (Name of Officer) (Title) of Gibson -Lewis, LLC having contracted with City of South Bend Board of Public Works �lS ( uboontraoto /S uplalier) (Contractor) to furnish certain materials and/or labor as follows: (Description) for a project ]mown as City of South Bend Fire Station #4 Project #116-066 ('Nave of Project) located at 220 N. Olive treet _w_outh Bend IN and owned by City of South Bend Board of Public Works (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: Dollars ITITm ) ❑ 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 One Hundred Sixty Seven Thousand Five Hundred Fifty Three &_l 8/100 ❑ 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 scope of this Affidavit and Waiver of Lien. Gibson -Lewis, LLC By (Firm) ....... __. (Authorized Reres ntative:) STATE OF INDIANA SS: ST, JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Robert A. Lingenfelter and acknowledged the execution of the foregoing Affidavit and Waiver of Lien, the 8th da �w IN WITNESS WH0 REOF I have hereunto subscribed name and affixed my o r s sea on y of day Vnf Notary Public Signature My Commission Expires: July 10, 2024 Elizabeth A. Biddle Residing in St. Joseph County, Indiana Notary rt lc° )c E L I ZA B ET H A. B I D D L E Notary Public, State of Indiana +r� t," St. Joseph County ,�a y My Commission Expires �u July 10, 2024 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 04/24/2019 Department Public Works Name Toy Villa Division/Bureau Engineering ..� .......................... _. BPW Date 05/14/2019 Phone Extension 5920 wwnvvrommvmx momrm��o Mmmuuiuummra�mmiwr�u �mmreirnmmmnirr m� OR MMMUmimuuuuwuu Required 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 El �m --- ______-....... Check the Agreement [❑ Professional Services ❑ Bid Opening F1 Quote Opening F-1 Change Order No. EJ Ease/Encroach. F� Other: Company or Vendor Name iropriate Item Typemm- El Contract El Resolution El Bid Award El Quote Award [] C/O &PCANo, El 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 d for All Submissions Proposal ❑ Req. to Advertise Required Information Gibson -Lewis, LLC Proiect Closeout Addendum ❑ Title Sheet ❑ Required Contractor's Certification Forms Attached (Non- _mmmm_mmCollusion, Non -Discrimination, wNon-Debarment, E Verify Iran, etc. quired ..FomCe Orders Only _.... Amount of ❑ Increase $ Decrease $ Previous Amount $ Current Percent of Change: %.�_�_....m.........�....................................................�........................... ...... ....._____ �N.. e........................�.�.�.�...........m.......�................................._.............. New Amount $ ...................................._............ �....._..._.................................................. Y Total Percent of Change: % Dispersal After Copy Original ❑ ❑ ❑ El F El