HomeMy WebLinkAboutProject Completion Affidavit - Code Enforcement Office Improvements - Brown & Brown General ContractorsON '1�g
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1865
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
July 23, 2019
Eric Brown
Brown & Brown General Contractors, Inc.
124 S Elkhart Street
Wakarusa, IN 46573
PHONE 574/235-9251
FAX 574/ 235-9171
RE: Project Completion Affidavit — Code Enforcement Office Improvements
Dear Mr. Brown:
The Board of Public Works, at its meeting held on July 23, 2019, approved the Project
Completion Affidavit for this project in the amount of $8,894.
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
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CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS`
PROJECT COMPLETION AFFIDAVIT'
mOffice Improvements
PROJECT NAME Code Enforcement ITITITm .. _...___ ....
PROJECT NO, N/A FINAL COST $8,894 _........w
CONTRACT SIGNED 2/12/2019 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION J x ansionmof the Inspector area in Code Enforcement office.
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.
t._m June 2019
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SignatL
Eric Brown, President
Printed Name
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WITNESSES
Brown & Brown General Contractors, Inc.
Company Name
124 S Elkhart St
...............
Company Address
Wakarusa, IN 46573-0487
City/State/Zip
Before me, the undersigned Notary Public in and for said country and state, personally
appeared Eric Brown , and acknowledged his/her signature to the above Project Completion
Affidavitdavviit on the 28th day of t111 _._._. , 201 9
id
Notary Signature
Todd A. Marek
My Commission Expires 4/3/2025
Printed Name County of Residence Marshall Co., IN
f the Contractor is a corporation, the following certificate will be executed.
I, Hannah M. Aitken ..................... certify that I am Secretary of the Corporation executing this release; that
Eric Brown 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
I
f,orp, ration by Aud �rity of its governing body, and is within the scope of corporate powers:
Secretta°y's Sigmatwbre
Hannah M. Aitken Corporate Seal
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for final approval and we recommend to the Board of Public Works that it be
ordained so.
Date:
Construct` "llanager
BOARD OF PUBLIC W I "S A
Q A. Gr p �I lent
M
�;L�'um L. O'Sul i`v n, 'herese J
PPROVAL Date:
Gencv�ve E. Miller„ Member Elizabeth A. Maradik, Member
Final Waiver of Lien
State oflndiana, County of Elkhart SS:
Eric Brown being duly awornthat he/she Isthe President
(Name of Officer)(Title)
of Brown & Brown General
o Contractors, Incbavlttgcontractedwith City of South Bend, IN
(Contractor) (Owner)
to fmish certain materials and/or labor as follows; complete construction
(Description)
for a project lmown as Expansion of the Inspector area in Code Enforcement Office
(Name of Project)
located at South Bend, IN
and owned by City of South Bend, Indiana
(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 acluxowledged; or
❑ the Payment of wt,dlticch has been promised as the sole consideration for this Affidavit and Final Waiver of ien'which is given
solely with respect to said atuouut, and which waiver shall be eftfeclive only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVED that the final balance due from the contractor is the sum of
Eight thousand eight hundred ninety-four and 00/100 dollars 8,894 00
❑ receipt ofwhioh is hereby aclatowledged; or
® the Payment of which has been promised as the sole consideration ibr this Affidavit and Final Waiver of Lien which shall
become offeetive only ttponrocclpt of such payment.
THEREFORE, the undersigned waives and releases: unto the Owtmr ofsald promises, any and all liana or claims whatsoever
on the above -described property and improvame"ts thereon as account of labor or material or both, fitruished b the undersigned
thereto, sUb,)ect to limitations or conditions expressed herein, if any; and further certified that no other party has any cteim or right to a
Jim on account of any wont performed or material ftunished to the undersigned for said p " ct ,, and withi scope ofthis Affidavit
and Waiver ofLien,
Brown & Brown General Contractors, Inc.
('�) (Ant a ed Representative)
STATE OF INDIANA )
SS:
ST. JOSEPH COUNTY )
Eefore me, the undersigned, a Notary Public, in and for said County and State, personally appeared Eric Brown
and aclmowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, Ihave hereunto subscribed try name and affixed my official seal on the 28th day of
June Zoo 2019 ,
Notary Public Signature
My Commission;'ii'xpito; 4/3/2025
Residing in Marshall County,
Todd A. Marek
.............................
Indiana Todd AMara
Notary PuNic o Pt�l
SEAL
Marshall County, State of Indiana
My Commission Expires April 3, 2025
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name
BPW Date
July 1,12019
Adam Parsons.,,,.,.,.m....��.. �...���������.......................�....._... Central Services
Jt1
2019
Phone Extension 9302
r to Submitta.. ....... �.. .
�.mmmm 1 to Board 1,��c��rcd Prior ....... _........
BPW Attorney X Attorney Name Clara McDaniels
Dept. Attorney ❑ Attorney Name
Purchasing ❑
Check the Appropriate Item °hype --
❑ Professional Services Agreement Contract
❑ Open Market Contract ❑ Amendment/Addendum
F] Bid Opening ❑ Bid Award
Quote Opening ❑ Quote Award
EJ Proposal Opening [ C/O & PCA No.
Chg. Order, No. F] Traffic Control
Other:
ared Jbr All Submissions
Required Information
L-1 Proposal
El Special Purchase, QPA
�] Req. to Advertise
❑ Reject Bids/Quotes
® PCA
Resolution
E] Ease./Encroach
.....___.
❑ Title Sheet
Company or Vendor Name
Brown and Brown General Contractors„ Inc.
.........�__........__...�_ � �,, .......... ��.
Yes If Yes, Approved by Purchasing
New Vendor
®No
❑❑ �❑
MBE/WBE Contractor
WBE Completed E-Verify Form Attached
Nos
Project Name
Code Enforcement Office Improvements.__
Project Number
..............................
Funding Source
Code Enforcement
Account No.
_._..._........................w..�.�.__................�....�..___.�����...�.
9-89
Amount$8,894......._�_��........
_600-1201._.41......�_
..-............................w _ � .-.............. �_ � ...� _._.................._.
Terms of Contract
......_... __................... _ ... _......�. w ... .... ...................
Lump Sum
Purpose/Description
........ .... ........ ... ..... _... -"��_.,���..._���....._���....... .-------------- _..........----- ........
Project Closeout
_.. —
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Amount of �
Increase $ ..... ..........�. m,��_.........�..
..__..�.. a,.���...
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Decrease �$ )
Previous Amount
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Increase.........._................._...�___�..�.�.............�....... �-.�..�.�.�.�.............................................................. �..�_....................._.
Current Percent of Change:
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New Amount
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Total Percent of Change:
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Time Extension Amount:
New Completion Date: