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Home My WebLink AboutProject Completion Affidavit - Lot 12 US 31 Industrial Park Landscape Work Project No 119-029 - Fuerbringer Landscaping and Design1316 •BUILDING BOULEVARD 16 r_ITY OF SOUTH B END PETE BUTTIGIEG, MAYOR i:1A';1 OF PUBLIC WORKS June 25, 2019 Dan Fuerbringer Fuerbringer Landscaping and Design, Inc. 22530 Brick Road South Bend, IN 46628 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Lot 12 US 31 Industrial Park Landscape Work — Project No. 119-029 Dear Mr. Fuerbringer: The Board of Public Works, at its meeting held on June 25, 2019, approved the Project Completion Affidavit for this project in the amount of $52,110. 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 fF BOARD OF PUBLIC WORKS t, ?1 PROJECT COMPLETION AFFIDAVIT PROJECT NAME Lot 12 US 31 Industrial Park - Landscape Work PROJECT NO 119-029 FINAL COST $52,110.00 CONTRACT SIGNED 3/26/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Install landscaping and irrigation at Lot 12 of US 31 Industrial Park WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the Ci''ly of,South Bend, its officials and agent re.hereby released from all claims and demands whatsoever arising under or by s h contract, and that the contra ® rformed the work within the scope of the Specifications and Standards of the City of outh Bend which were a par the above Contract. thi � d4 of 4... 01 )A n... .. Printed Name Fuerbringer Landscaping and Design, Inc. Company Name 22530 Brick Road Company Address South Bend, IN 46628 City, State, Zip WITNESSESS: Before r �e the undersigned Notary Public in and for said country and state, personally appeared ��,.. �.-k and acknowledged his/her signature to the above Project Co ? :� p the "u d ay of OFFICIAL SEAL 201 r„ ALICE M. McKINLEY `i NOTARY PUBLIC - INDIANA ST. JOSEPH COUNTY r a Notary Signature My Commission Expires o , Expdr�9/2612024 �" u = e Count of Residence ?, „ Printed Name y£ If the- Contractor Is corporation, the following certificate will be executed. I, 1 i "igly�e certify that I am Secretary of the Corporation executing this release; that . who signed this release on behalf of the contractor was then • r Z mow, �, 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: tu" Signature Si Corporate Seal Printed amd DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for f' proval and we recommend to the Board of Public Works that it be ordained so.. Date: — Construction er % BOARD OF PUBLIC WORKS APPROVAL Date:'' 1 _A Gary A. Gil t"„ President Genevieve E. Miller, Member Elisabeth A. Maraclik, Member Therese J. "' 6U, Member Laura O'Sullivan, Member nda M. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN PROJECT NUMBER: State of INDIANA, County of S'T. JOSEPH ss: The undersigned, being first duly sworn, states, warrants and deposes, personally and as a duly authorized officer or representative of the Subcontractor as designated below (referred to herein as "Subcontractor") as follows: Dosicination of Instrument This is a: ❑X Partial (Affidavit & Waiver of Claims) ®Final (Affidavit & Waiver of Claims) And is: [Conditional (Payment To Follow) ❑Unconditional (Payment Received) HUMER M 0 0 Subcontractor Name: FUER'BRINGER LANDSCAPING AND DESIGN INC. Subcontractor Address: 22.53Q BRICK a AD — SOUTH BEND INDIANA 46628 Name of Person Signing: DANIEL R. FUERBRINGER Title: PRESIDENT/OWNE R Project (Name): Lot 12 US 31 Industrial Park Project Location/Address: Contractor: Owner: City of South Bend Board of Public Works Payment Amount: Two Thousand Six Hundred Five Dollars nd 50M00, 2 605. 0 Payable through the period ending (date): May 13, 2019 (referred to herein as the "Effective Date") The Terms of This Instrument Are: f. Subcontractor has contracted with Contractor to furnish labor, materials, equipment and/or services in furtherance of Contractor's contractual obligations for the described project. 2. If this instrument is designated as a Partial Affidavit and Waiver, the Payment. Annount recited above is the; current balance due the Subcontractor, and such amount, together with any and all previous payments received by Subcontractor, is the total sum due to Subcontractor, exclusive of contractually, provided retainage, for all labor„ materials„ equipment or services furnished by or through Subcontractor to or for the Contractor in respect of the Project through the above stated Effective Date, if this instrument is designated a Final Affidavit and Waiver, the Payment Amount is the full and final amount due the Subcontractor for any and ail labor, materials, equipment or services furnished or to be furnished by or through the Subcontractor for the Project. 3. The listing on the attached Application For Payment form is incorporated hereon by reference and sans forth, fully and correctly, the names of sub -subcontractors, materialmen, equipment lessors and laborers engaged by or under the ernvp, cy of subcontractor and to whom monies are presently due and owing from Subcontractor for labor, materials, equipment or services iLar°jj shed to or for the Project. Except as otherwise specifically stated in such listing in sub -subcontractors, materialmen and laborar i engaged or employed by Subcontractor have been paid in full for all labor, materials, equipment or services furnished In respect of Um projecL 4. In consideration of payment of the Payment Amount, the Subcontractor completely waives, discharges and releases the Contractor, any and all owners of any title or interest in the real estate upon which the project is situated, wwl their respmu ctive sureties, successors assigns„ from all liens and claims whatsoever in respect of or arising from any and all labor„ rnaiarlals, eqUl3rrierat or services furnished by or through Subcontractor to or for the Project„ including without limitation mechanics, liens and clainas against any contract proceeds. If this instrument is designated as a Partial Affidavit and Waiver, the waiver„ discharge and release paovidad by this paragraph shall, apply only to labor, materials, equipment or services furnished on or before the Effeciiva Date haraof. if this instrument is designated as a Final Affidavit and Waiver, the waiver, discharge and release provided by this paragraph shall notwithstanding the Effective [date of this Instrument. 5. The undersigned and Subcontractor will indemnify Contractor and hold it harmless again any loss, cos, or expemse, including cost of bond premiums, litigation expenses and attorney fees„ for and in respect of any breach of any r,cvarmlt, fePrr sentation or warranty contained herein or any lien or other claim asserted by any person in respect of labor, materials, egLJ pWn:at�� or ser vices which are within the scope of this instrument. 6. If this instrument is Conditional, the terms eof shall ecome effective upon paymer of -the Payment Amount to Subcontractor, or at Contractor's option, jointly to Subcontra r and any pe , ons identified and in r cuve amounts as stated on the attached Application For Payment form, which payment sh the sole consi oration of this Aff' it and Waiver. If this instrument is designated above as Unconditional, the undersigned and S contractor ack owl2recei of the Payment Amount and agree that this instrument shall be effective in all respects as of the dat ereof. m.�..., • Subcontractor's Signature. Subscribed and Sworn to befor,, me this 13 day of lay 2019, Notary Public Signature: � �� My Commission Expires: Le _�66 2024 Printed Name: 'ding �m Count y ng in: �; �l� AI IMF iWl ii�lc IC LEY If , nt �'„ tllrfllt l Ulll IC IIICil6iflll CtLldy'fy `. My Comm. Fxpiros 9126/2024 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 6/11/2019 Department Public .. e Name Toy Villa ... —.... �. .�.�....A.. Works ... _... .... —.... _ .._. _.. BPW Date 6/25/2019 Phone Extension 5920 mmEmmwm w�m�n��rnn�c... uwuwwwwmmmmarmmr iuiuiuiuurtai.... . �M �... mimuim a uuuuu�uuw Required Prior to Submittal to Board BPW Attorney Attorney Name Dept. Attorney Purchasing R Attorney Name Check the Item T ry — Reauire &P, All Sub LJ Professional Services Agreement LJ Contract Open Market Contract El Amendment/Addendum El Bid Opening EJ Bid Award j Quote Opening E Quote Award []' Proposal Opening E] C/O & PCA No. E] Chg. Order, No. E] Traffic Control Other: Company or Vendor Name F New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information Lj Proposal E] Special Purchase, QPA Req. to Advertise ❑ Reject Bids/Quotes ® PCA Resolution Ease./Encroach and Design, Inc. ❑ Title Sheet U Yes" If Yes, Approved by Purchasing ® No ❑ MBE Completed E-Verify Form Attached ❑ Yes F] WBE No Lot 12 Landscape Work 119-029 S 31 Industrial Park Lanca m � River West TIF 324-1050-460-42.01 - .Ol 52 110.00 Project Closeout �� .... ..�..�.�.� ... For Cki�,ui� Orders �aa,....._. ��.�__... ..�.. �..._�_....�w � �...... Amount of ❑ Increase $ El Decrease ($ ) Previous Amount $ Increase /o Current Percent of Change: Decrease %) New Amount $ _ Increase.....�................._.......�...........................% ..............��m�.. �...................�.�...�......�..�,....�............w..................�......��................... Total Percent of Change: Decrease..........��%)...............m....................�_....._�... _......�................ _..r. Time Extension Amount: ... .m.. ... .......... m.. New Completion Date: