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Home My WebLink AboutProject Completion Affidavit - 2019 Small Drainage-Lathrop Project No 119-019A - Selge Construction Inc1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOIITH BEND. INDIANA 46601-1830 U & n �F4 MACE 186,5 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDU LIC WORKS August 13, 2019 Robert Kuhns Selge Construction Co., Inc. 2833 S I11h Street Niles, MI 49120 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — 2019 Small Drainage -Lathrop — Project No. 119-019A Dear Mr. Kuhns: The Board of Public Works, at its meeting held on August 13, 2019, approved the Project Completion Affidavit for this project in the amount of $36,605.40. 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 . BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT" PROJECT NAME 2019 Small Drainage . Lathrop PROJECT NO 119-019A FINAL COST $36,808 40 CONTRACT SIGNED 4/9/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION 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 day of J , 201 9 Sela Construction Co., Inc. I � �,,,.,.�. ' Company Name Signature 2833 S. 11th Street Company Address Printed Name Niles, MI 49120 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared EQbUt K and acknowledged his/her signature to the above Project Completion Affidavit on th 2r;t-h day of .1201 9 M./, Notary Signature My Commission Expires 07 2S 2Q20 __ Berrien Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed,. Ia Vicki A-. Priest certify that I am Secretary of the CorporOoli`6 0 trW)q this release; that who signed this release on bet&,was then o I h� behalf of said of said Corporation; that said release w I 1 f ratio b A� c � MY COMMISSIONIC Y 9 Y, P p its vernw o an is within a scope o co ora o ' Secretary's Signature EXPIRES 1 25-202o 'W "" Corporate Seal Vicki A- prigz Printed Name" g� t✓4Q DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptab'e for al approval and we recommend to the Board of Public Works that it be ordained so. Date: Iq Constructi aaer Final Waiver of Lien State of Indiana, as: WHEREAS, the undersigned Selge Col ' ii ' struction Co.., I pc.. has been heretofore employed by the City of South Bend, Indiana to furnish certain material and labor, to wit: 2019 Small PLain for the real estate owned by the°�it� ol�Soattl f3mad located in South Bend, IN County of St. Joseph, State of Indiana, Now Therefore, Know Ye, That the undersigned, for and in consideration of Thirteen Thousand Seventy Eiaht Dollars and Sixty Five Cents ($13,078,65.1, the receipt of which is hereby acknowledged, hereby and now waives and releases unto the said owner of said premises, any and all lien, right of lien or claim of whatsoever kind of character on the above described real estate. TO AND FOR SAID AMOUNT, an account of any and all labor material, or both furnished for or incorporated into said real estate by the undersigned up to this date, and we further certify that the consideration moving to the undersigned for executing this Partial Waiver of Lien has been mutually given and accepted as partial payment to or on account of the said project for said real estate. Signed, sealed and delivered this 25th day of July, 2019. Signed Robert Kuhns Project Engineer Personally appeared before me this 25th day of July,,,) obert Kulms _ 10 �]) who, being duly sworn on oath, says: That he is Project Engineer of the Selge (,onstrLIC6011 Co., Inc. and that he hereby acknowledges the execution of the foregoing instrument for and on behalf of said Sere ConstrLieLtioll CoamJgc. My Commission expires: 07/25/2,020 otary Pu N( NOTAR PUBLIC my comil S S 10 N EXPIPES 7-25-2020 ic-o" BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 8/05/2019 Department Name Villa. ........ Engincering Division BPW Date 8/13/2019 Phone Extension 5920 R sired Prior to Submittal to Board ................._._..........�_w_.... _......_._._.__W_ ..............._ BPW Attorney ❑, Attorney Name Dept. Attorney F-1 Attorney Name Purchasing Check the Appropriate Item Type ❑ Professional Services Agreement ❑ Contract Open Market Contract Amendment/Addendum ❑ Bid Opening Bid Award Quote Opening [' Quote Award Proposal Opening C/O & PCA No. Chg. Order, No. ❑ Traffic Control 0 Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description vdJor All Submissions ;Required Information Construction LJ Proposal El Special Purchase, QPA E] Req. to Advertise E] Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach ❑ Title Sheet Yes" If Yes, Approved by Purchasing ® No ❑ MBE Completed E-Verify Form Attached Yes ❑ WBE No 2019 Small Drainage (Lathrop) ............................w Storm Sewer Fund 667.mmmmmmmmmmmmmm0621.792.42.04 $36,605.40 Project Closeout For Clue Orders Only; Amount of ❑ Increase $ ❑ Decrease ($ Previous Amount $ Increase.............._�.�.�.�.�.�.�.�.�.�.�.................. ° /o Current Percent of Change: Decrease ( % New Amount $ _ Increase % Total Percent of Change: Decrease Time Extension Amount: New Completion Date: