HomeMy WebLinkAboutProject Completion Affidavit - Light Up South Bend Riverside Lighting Project No 118-011A - Martell Electric LLC1316 COUNTY —CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1 930
Jennifer Martell
Martell Electric LLC
4601 Cleveland Road
South Bend, IN 46628
I'.. I'M•:rn.A".fir .:
I111�n�
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 — Light Up South Bend — Riverside Lighting — Project
No. 118-OIIA
Dear Ms. Martell:
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 $103,189.20.
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,
UOV41_�,
Linda M. Martin, CI : rO
ll
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 t o° "z
PROJECT COMPLETION AFFIDAVIT�mv.
PROJECT NAME Li ht U South Bend - Riverside Lighting
PROJECT NO 118-011A FINAL COST $103,189.20
CONTRACT SIGNED 7/24/2018 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Install new conduit and wirinq alonq Riverside Dr. for lighting LED retrofit.
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.
Exet d his day of
4th A riI N_ r' 2019 Martell Electric. LLC
�n
Company Name
Sig e e 4601 Cleveland Road
Jen i r Martell Company Address
Printed Name
South Bend, IN 46628
City, State, Zip
WITNESSETS:'
yptjuloo, RENA BALDWIN
Before me, the undersigned Notary Public in and for said country and state, personally a ` N nary Public, state of Indiana
Jennifer Martell and acknowledged his/her signature to the above Project Co trbrr�° 11ar vl orr,t Joseph Coumy
the 4th day of April 201 SEA, Commission S 663664
l � r `;" My Commission Expires
;`,�+` February 28, 2023
Notary Signature My Commission Expires 02/28/2023
Rena Baldwin
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
Printed Name
Corporate Seal
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project i cceptable for "n approval and we recommend to the Board of Public Works that it be ordained so.
Date: 1
ConstruottVol oger
r
BOARD OF PUBLIC WORKS APPROVAL Date:
Gary A. Gilot, President r?,e F AAkj—Member Elisabeth A, Maradi , Member
Therese J. Dorau, Member
AFFIDAVIT AND WAIVER OF LIEN
0 Final ❑ Partial El Payment to Follow
STATE OF: Indiana
COUNTY OF: St. Joseph
Jennifer Martell being duly sworn, deposes and says that she makes this
affidavit for and in behalf of MARTELL ELECTRIC, LLC which, having entered into an agreement with
City of South Bend ("Contractor") for the construction of Riverside Drive lighting
on the premises of the owner located at Riverside Dr
states that, upon receipt of payment by Martell Electric from Contractor in
the amount of Thirteen thousand nine hundred seventy five & 27/100 Dollars,.
(the "Payment"), which payment has been promised by Contractor and is anticipated by Martell Electric,
all material and subcontract, due and payable, will have been paid and all labor paid in full to the date of
this affidavit EXCEPT for:
CONTRACT
RETENTION
Effective upon receipt by Martell Electric of the Payment, Martell Electric does waive and release unto the
owner of said premises, any and all lien, right of lien or claim of whatsoever kind of character on the
above -described building and real estate under the Statutes of the State of Indiana
relating to Mechanic's liens, on account of any and all labor, material, or both, furnished for or
incorporated into said building by the undersigned, up to this date.
MARTELL ELECTRIC, LLC
B
Subscribed and sworn to before me,
\,J Jennifer Martell
(Printed Name)
President
(Title)
on this 4th day of April, 20190n",�;°�«
RENA BALDWIN
4
Notary Public, State of Indiana
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d'P6�
St Joseph County
Commission # 663664
" �;
My Commission Expires
Notary Puhilic
M��r"w
February 28, 2023
My commission expires: 2/28/2023
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date _04/24/2019
Name To V �__.....
y v.
ills Department Engineering
BPW Date 05/14/2019 Phone Extension 5920
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w w Required Prior to Submittal to Board
......._ _ ............... .. - _.....--........ — .....-v .-........-.---------
Legal E] Attorney Name
Controller Controller review is required for all Contracts $5,000.00 or more anc
greater than one year in length per the City Purchasing Policy
Purchasing
Check the
LJI Agreement
El Professional Services
Bid Opening
❑ Quote Opening
❑ Change Order No.
El Ease/Encroach.
E] Other:
)ro riate Item T O e ire for All Submissions
Contract _.. �... ......._..-.........
I� E] Proposal C Addendum
El Resolution
Bid Award ❑ Req. to Advertise ❑ Title Sheet
Quote Award
El C/O & PCA No. ® PCA
❑] Traffic Control
Required Information
Company or Vendor Name Martell Electric, LLC
New Vendor ❑ Yes Ell No ❑ If Yes, Approved by Purchasing
MBE/WBE Contractor ❑ MBE []I WBE
MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company
Project Name
Project Number 1.1 ..,.,.......� Riverside Li c hting .m._..
ht U South Bend -
Funding Source COIT
Account No. 404.0602.431.31.06
Amount $103,189.20
Terms of Contract
Purpose/Description Project Closeout
-❑ Required Contractor's Certification Form Attached (Non -
Collusion„ Non -Discrimination, Non -Debarment, E-Verif, Iran, etc.
uired For Change Orders On
Amount of El Increase $
❑ Decrease ...$
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Dispersal After Approval
Copy
Original
11
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