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Home My WebLink AboutProject Completion Affidavit - Century Center Mezzanine Project No 118-036R - R Yoder Construction Inc1316 COUNTY-Crry BUILDING 227 W. JEFFERSON BOULEVARD R OUT11 1865, CITY OF • BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS July 9, 2019 Randall Yoder R. Yoder Construction, Inc. 27453 CR 150, PO Box 69 Nappanee, IN 46550 PHONE 574/ 235-9251 FAX 574/ 235-9171 RE: Project Completion Affidavit — Century Center Mezzanine — Project No. I I 8-036E Dear Mr. Yoder: The Board of Public Works, at its meeting held on July 9, 2019, approved the Project Completion Affidavit for this project in the amount of $104,243.52. 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 ��wads Md p CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT " PROJECT NAME Centu Center Storage Mezzanine PROJECT NO 118-036E FINAL COST $104,243.52 CONTRACT SIGNED 2/12/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Construction of stora a mezzanine at Centu Center 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. cuted d o �j� 201R. Yoder Construction„ Inc. Company Name Signature 27453 County Road 150 1,/m Wt,,0 ,, - _ - _ _ _ - _ . _ Company Address Printed Name Notary PuNfr stale of I64ana Nappanee, IN 46550 lkha d .Crum 4 mirftsi n #1 NP012,0458 City, State, Zip My Ccrnmissfort Expires WITNESSESS: a"tar Before me the undersigned Notary Public in and for said country and state, personally appeared , and acknowledged his/her signature to the above Project Completion Affidavit on the � � day of 3-uy\-e- 12019 Notary Signature My Commission Expires 5-' J Printed Name County of Residence eiti-har+ 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 tivI t. ti r 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 C Upoal,,n by tl rity of its governing body, and is within the scope of corporate powers: Secretary's ignat rre Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for fir V approval and we recommend to the Board of Public Works that it be ordained so. Date: �Construrtio ti, roger BOARD OF PUBLIC WORKS APPROVAL Date„ AJ&Ln mi Jtt tiL "I Gary A. Gilot, P esident Genevieve E. Miller, Member Elizabeth A, Maradik„ Member Therese J. OoraU, Member Laura O'Sullivan, Member inda M. Martin, Jerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of Elkhart SS: Randall E. Yoder being duly sworn that he/she is the President (Name of Officer) (Title) of R. Yoder Construction, Inc. having contracted with Qty gf 5gwth Bend, QeD@[Jm@nJ cf PgNig W rks (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: materials and construction for storage mezzanine (Description) for a project known as Centu Center Stora a Mezzanine (Name of Project) located at 120 Dr. Martin L ther Kin r. Blvd South Bend and owned by Ci!y of^South Bend Department nt of Public Works (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 Five thousand two hundred twelve dollars and eighteen cents $ 5212.1 ❑ 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. R. Yoder ConstructionA�nv e Inc. By (Firm) (Authorized R resentative) STATE OF 17IANA ) ) SS: lr'F-4©&BPi+f-#R►1-TY Elkhart ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared 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 My Commission Expires: 05- -2 Residing in Elkhart County, Indiana Randall E. Yoder Notary Public Signature Annette Wiseman Notary Public Name 1 th day of BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 6/24/2019 Name T.oy Villa ............................._. ...............�.�.�.� ....�� Department:.......... Eng.neering........w�� ,,,,,.._.._................ BPW Date 07/09/2019 Phone Extension 5920 iwuw�uuw��wwww!mmmi��w��w� wuuuuuH ......,�^� u�.��^tt,�..� --, u,��rvs��muuuuuuumuwmumw�wimwwwwwwwwu�w�mrra�wr�mvna ,......, rUwrm.wrr mmn��ix� Required Prior to Subm ittal mittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney E Attorney Name Purchasing El ................. _............... .... _._.. ___.._.-�....— Check the Appropriate Item Type — Required for All Submissions H Professional Services Agreement L_, Contract ❑ Open Market Contract Amendment/Addendum Bid Opening Bid Award ❑ Quote Opening EJ Quote Award ❑ Proposal Opening C/O & PCA No. n Chg. Order, No. ❑ Traffic Control F� Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information LI Proposal E] Special Purchase, QPA Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes PCA Resolution Ease./Encroach R. Yoder Construction, Inc Yes 0 If Yes Approved by Purchasing ® No ❑� MBE Completed E-Verify Form Attached No WBE Century Center Storage Mezzanine 118-036E Hotel Motel Tax Fund 73 04.42010.000.0099 $104,243.5 ProJc0' 'loscout. _............................... _ ... _____ ....... _............. ...._ For'Clian,p Orders Only Amount of Increase $ _ _.__..e Decrease �._$...� _._. �.....�� Previous Amount $ .............. Increase �.............................._..........w�................w�,.. % Current Percent of Change: Decrease ( %) New Amount $ Increase % Total Percent of Change: Decrease Time Extension Amount: New Completion Date: