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Home My WebLink AboutProject Completion Affidavit - Lot 12 US 31 Industrial Park Asphalt Paving Project No 119-026 - Almac SotebeerBUILDING1316 COUNTY -CITY BOULEVARD ,"ov 1*11 11 ` �n PEACE 1865 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR PUBLICBOARD OF WORKS July 9, 2019 John Sotebeer Almac-Sotebeer, Inc. 3414 County Road 6 East Elkhart, IN 46515 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Lot 12 US 31 Industrial Park Asphalt Paving — Project No. 119-026 Dear Mr. Sotebeer: 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 $35,975. 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 �� y BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Lot 12 US 31 Industrial Park Asphalt Pavin PROJECT NO 119-026 FINAL COST $35,975.00 CONTRACT SIGNED 4/9/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Placement of HMA surface and striDina of Darkina lot. 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. Executed this 18th day of June 201 9 Almac-Sotebeer, Inc. Company Name 701"n re 3414 CountyRoad 6 East . C . Sotebeer Company Address Printed Name Elkhart, IN 46515 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared John C . Sotebeer „ and acknowledged his/her signature to the above Project Completion Affidavit on the 18th day of June 201 9 Notary Signature My Commission Expires Kim M. Jennings Printed Name 12/28/24 County of Residence Elkhart If the Contractor is a corporation, the following certificate will be executed. 1, Jane Sotebeer certify that I am Secretary of the Corporation executing this release; that John C . Sotebeer who signed this release on behalf of the contractor was then President of said Corporation; that said release was duly signed for and on behalf of said Co oration by Auth rd of its governing body, and is within the scope of corporate powers: Secre ry's Signature Corporate Seal Jane Sotebeer Printed Name � DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for "in approval and we recommend to the Board of Public Works that it be ordained so. b ;, � � Date: . lei Constructian ager Elk - Gary A. Gilot, resident BOARD OF PUBLIC WORKS APPROVAL Date: 0 V " Genevieve E. Miller, Member Therese J. DoradKember � L. aura O'Sullivan, Member 1AT_A'UJZ--- Elizabeth A. Nkadik, Member Tip a M. Martin, der State of Indiana, Elkhart County, ss: Whereas, the undersigned Almac-Sotcbccr Inc., P.O. Box 1997 ElkhartIN 46515 has been heretofore employed by City of South Bend/Board of Public Works 227 W. Jefferson Blvd. South Bcnd 1.N 46O1 Pro°cct 11.9-026 to furnish certain material and labor, to -wit: Asphalt Paving for the building owned by REW LLC / M:r. Robert Wozn / 5l 00 Stratton Court / Granger, IN 46 .30-and located at 5870 Carbon. ill Drive / South Bend, IN. Now, Therefore, Know Ye, That the undersigned, for a good and valuable consideration, Thirty-five tlaoUsand nine hundred seventy-five & 00/100 dollars � 5,975.00'l, the receipt of which is hereby acknowledged, hereby and now waives and releases unto the said REW,_LLC / Mr. Robert Wozn / 51500 Stratton Court / Qjqjjger IN 46530 the owner of said premises, any and all lien, right of lien, or claim of whatsoever kind or character on the above described building and real estate, on account of any and all labor or material, or both, furnished for or incorporated into said building by the undersigned; and we further certify that the consideration moving to the undersigned for executing this Waiver of Lien has been mutually given and accepted as absolute cash payment and not as a conditional or part payment or as security for payment. Signed, sealed and delivered this 12th day of June , 2019. Signji-c'sidernt , aa. C. So c ee Personally appeared before me this 12th day of June, 2019 . John C. Sotebeer who being duly sworn on oath, says: That he is President of _Almac-Sotebe r, Inc. and that he hereby acknowledges the execution of the foregoing instrument for and on behalf of said Corporation and at their special instance and request. My Commission Expires: 12/28/2024 Kim M. Jennings Notary Public Resident of Elkhart County DESIGN - DEVELOPMENT m� CONSTRUCTION - LEASING - REAL ESTATE 3414 Co. Rd. 6 East - PO. Box 1997 - Elkhart, IN 46515 -� (574) 264-5507 - (FAX) 262-2204 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 06/24/2019 Tov Villa Department: Engineering BPW Date 07/09/2019 Phone Extension 5920 mauxrxr i�rr�eu�n. w�mmm�uouuuuuuuuuuumnnmimmmmmmmmmmmmmmmmmuuuuuuuuuuuumwwwmmmumm imwimumi �Required Prior to Submittal to Board �....._ IT BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Aq�Propriat Item Type — l ruxr Professional Services Agreement Contract ❑ Open Market Contract ❑ Amendment/Addendum Bid Opening Bid Award Quote Opening ❑ Quote Award EJ Proposal Opening C/O & PCA No. F Chg. Order, No. ❑ Traffic Control 17 Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Pro 'Cct Closeout l6r All Submissions ❑ Proposal _.._...._ ❑ Special Purchase, QPA E] Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ® PCA Resolution 1 Ease./Encroach ..... Cl��~�:c Orders O��ky Amount of Increase $....... Decrease ($ Previous Amount $ Increase % Current Percent of Change: Decrease %) New Amount $ Increase % Total Percent of Change: Decrease (. % .._.. Time Extension Amount: New Completion Date: