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Home My WebLink AboutProject Completion Affidavit - Fire Station Nos 10 and 11 Equipment Proj No 118-108 - Herrman and GoetzING f �i ► mVARD .J CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLICWORKS May 28, 2019 Larry Cripe Herrman and Goetz, Inc. 225 S. Lafayette Blvd. South Bend, IN 46601 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Fire Station Nos. 10 and 11 Equipment — Project No. 118-108 Dear Mr. Cripe: The Board of Public Works, at its meeting held on May 28, 2019, approved the Project Completion Affidavit for this project in the amount of $47,287. 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, INDIANA41 BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT." PROJECT NAME Fire Station 10 & 11 Equipment PROJECT NO 118-108 FINAL COST $47,287.00 CONTRACT SIGNED 12/20/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Install Gear Extractor and Soap Dispensing Systems at Fire Stations 10 & 11.. 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. ExeCu ,Q -* ------- a-y._ 201 g _ Herrman and Goetz, Inc. Company Name Si ature 226 a, Lafayette Blvd La6y Cripe, P. 0. A. Company Address Printed Name South Bend, IN 46601 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared __,Larry„__QIL _, and acknowledged his/her signature to the above Project Completion Affidavit on the day of 201�_. Notary Signature My Commission Expires 7/13/2022 Catherine J. Gruber Printed Name County of Residence It-- jaseph If the Contractor is a corporation, the following certificate will be executed. 1, Kathleen A. Herrman certify that I am Secretary of the Corporation executing this release; that �L 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 Cor or do by A t rAt f its governing body, and is within the scope of corporate powers: Secretary's Signature Kathleen A. Herrman Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project Is acceptable for ' al approval and we recommend to the Board of Public Works that it be ordained so. Date: 4. 12t o t Construction "er BOARD OF PUBLIC WORKS APPROVAL Date: Gary A. Gilot, President Gea vieve E. Mi l r fOember Elizabeth A. Maradik, Member herese X Cf6,rau, Member aura O'Sullivan, Member da M. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of St- Joseph SS: Larry --- Cripe being duly sworn that he/she is the Power —of —Attorney _ _ (Name of Officer) _._ .. (Title) of Herrman & G- et.z_,_ Inca having contracted with _ Subcontractor/Su her �'--'�•••-��n�th„Ben ( pp ) (Contractor) to furnish certain materials and/or labor as follows:-1eelaar1-al work — for and owned by uQi of South Bend _W.............__ — (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 Forty seven thousand two hundred eighty—seven Dollars $47( ,2B7.0 ❑ 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 parry 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. Ile Herrman & Goetz, Inc STATE OF... _........ ( .) _ ). (.. m.... _.. Fug �� ....� ..��.... Au rb�ed Representative).. 1NDIANA SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Larry Crip � _„ ,„ and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the _I_& day of May MX2019 211 Notary 1, i hc, Sogl tore My Commission Expires: 7 / 13 / 2022...... Catherine J. Gruber g Jose _h County, ln.diaraa.... _.....__ NotPublic Residing in St . P Notary Name POWER OF ATTORNEY I, Thomas J. Herrman, President and Resident Agent of an Indiana Corporation in good standing known as Herrman & Goetz, Inc., do hereby nominate and appoint Larry Cripe, an employee of said Corporation, who resides at 67950 Yankee Lane, Edwardsburg, Michigan to act as attorney -in -fact to do the following acts for me in my name, as President and Resident Agent. 1. To possess the full powers to execute and enter into all business related contracts on behalf of the Corporation, as any other authorized agent of said Corporation would have the ability to sign/execute, including myself. 2. The powers granted by this document shall begin on July 1, 2018 and conclude/expire on June 30, 2019 or to such other extended time as shall be made by written faxed extension executed by me to this authorization. 3. The powers extended by this document may be filed for record in any public office as just circumstances might dictate and the original and all executed duplicates shall have equal force, validity and effect. I declare, as President and Resident Agent of Herrman & Goetz, Inc. that any lawful act or thing done under the powers granted by this Power of Attorney, shall be binding on the Corporation. IN WITNESS WHEREOF, I, Thomas J. Herrman, President and Resident Agent of Herrman & Goetz, Inc. have signed this instrument on this the 23rd day of June, 2018. Thomas J. Herrman President and Resident Agent Herrman & Goetz, Inc. Subscribed and sworn to before me, a Notary Public, residing in St. Joseph County, State of Indiana, this the 23rd day of June, 2018 Catherine J. Gr er Notary Public Residing in St. Joseph County, State of IN My Commission Expires .-.., 7/1312022 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 05/14/2019 Department Name....... _ Toy Villa, �� Iniineerin .— .............— BPW Date 05/28/2019 Phone Extension 5920 n�� i rmu. m, �+ i IIP'1XfA 4NNNNNIW W cc u�_Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name ,,.---- Purchasing Check the A � ate Ite __._.. m Tyl c — equireda16r All Submissions ❑ Professional Services Agreement Contract Open Market Contract ❑ Amendment/Addendum Bid Opening ❑ Bid Award Quote Opening E] Quote Award ❑ Proposal Opening C/O & PCA No. 0 Chg. Order, No. Traffic Control F] Other: uired Information Company or Vendor Name Herrman & C3octz, Inc. New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description j Proposal El Special Purchase, QPA El Req. to Advertise E] Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach ❑ Title Sheet LJ Yes LJ If Yes, Approved by Purchasing No E] MBE MBE Completed E-Verify Form Attached El Nos Fire Station 10 & I Equip ment............................................................... ...��_�_ 118-108 _ Equipment wPurchases/ Materials & E ui ment ,.... T ..�. m.�. _� .. 287.0902.422.43.10 $47,287.00 —Project—Closeout ... ... For Chang_ Orders Only�� __... ....... m .�®��._......� ._........_.�w_ Amount of Increase $ Decrease ($ ) Previous Amount $ ......Increase........ w...._.�. Current Percent of Change: Decrease ( % New Amount $ Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: