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Home My WebLink AboutProject Completion Affidavit - East Bank Sinkhole Repairs Project No 118-305A - Northern Indiana Construction Co Inc1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOI ITH BFND. INDIANA 46601-1930 i rFAc•c�� ryw 186 CITY OF • BEND PETE i MAYOR BOARDOF PUBLICWORKS August 13, 2019 David Walorski Northern Indiana Construction Company, Inc. PO Box 1333 Mishawaka, IN 46545 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — East Bank Sinkhole Repairs — Project No. 118-305A Dear Mr. Walorski: 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 $83,210.75. 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 yµM47�V fiM p�. � CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT d PROJECT NAME East Bank Sinkhole Repairs Base + Alt2 PROJECT NO 118-305A FINAL COST $83,10.75 CONTRACT SIGNED ... ..... 4/23/2019 MAINTENANCE AGREEMENT ENDS Construction of repairs to city facilities including landscape and hardscape items such as sidewalk, curb, slope repair and stabilization, and other appurtenant work along the East Bank PROJECT DESCRIPTION Riverwalk within the City of South Bend, IN. 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. Northern Indiana Construction Company, V his h da f pi Inc. Company Name Signature P. 0. Box 1333 David J. Corski, President Company Address Printed Name Mishawaka, IN 46545 City, State, Zip WITNESSETS: Before me, the undersigned Notary Public in and for said country and state, personally appeared David ,T_ Walorski , and acknowledged his/her signature to the above Project Completion Affidavit on th 30th da w Julyi, 201 9 Notary Signature My Commission Expires April 16, 2025 Danisha L. Marable Printed Name County of Residence St. Joseph 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 David J. Wlorski 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 Corpor i by Authority of its o nng body, and is within the scope of corporate powers: .,. " Secretary's Signature Corporate O Seal Scott Fredrick Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL project p . pp Date: This ro�ect is acre tbte for nal approval and we recommend to the Board of Public Works that it be ordained so. 71. WW Constructs alter,,,._ BOARD OF PUBLIC WORKS APPROVAL Date: Gary yA. GilGilot, President Genie ve .Miller, Mesa "' l wzabe Mara,ik Memb 4. Alt, er J. Do V,,'Member U,1aura O'Sullivan, Member" `-Gr(da M. Martin, Clerk Final Waiver of Lien State of Indiana, County of St. Joseph SS: David J. Walorski m — being duty sworn that he/she is the President (Name of Officer) r) (Tine) Of NCX-tJiejai-ladiana—Constructimhaving contracted with City of South Bend, Board of Public Works (Contractor) (Owner) to furnish certain materials and/or labor as follows: AS Needed to Repair Sinkhole at East Bank (Description) for a project ]mown as East Bank Sinkhole Repairs, Project No. 118-305A (Name of Project) located at East Bank, South Bend, Indiana and owned by City of South Bend Indiana (Owner) and does hereby further state on the behalf ofthe 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 tbereofby the undersigned; �Iourt —Sevnt s . _ y T our D WAIVER) that the final balance due from the contractor is the s of ourty-Seven Thousand Two Hundred Niet Four Dollars and Ten C ❑ 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 onlyuponreceipt 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 ry claim or ri to a lien on account of any work performed or material furnished to the undersigtt r s d project, and within the s pe of this vit and Waiver of Lien / -) A ,, .4 /7 Northern Indiana Construction Co.,Inc.�� ° �..�'""`' David J. alorskip Presi ) ( ra red Re resenhativ),r�rs ... STATE OF 1NDIANA ) dent } SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared David J. Walorski and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my .cl l' seal on ti 30th day of Jul 20k 19 Notary Public � Signature . My Commission Expires: April 16, 2025 Residing in St. Joseph County, Indiana Danisha L. Marable Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 8/05/20.19 Department Public Name Toy Villa BPW Date 8/13/2019 Phone Extension 5920 ; immuwaurvw il�mmmmommmmmmnmmmmmmmmmmumummmmmummmmmmmmuuuuuuuuuuuu i mm�arwmmWwm w0000000000000o ivimmw.mwmmMEMO rmm� RR quir,Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney Purchasing Attorney Name Check the Ammo rl Item Type — l'iequired,l r All Submissions H Professional Services Agreement II Contract Open Market Contract ❑ Amendment/Addendum Bid Opening ❑ Bid Award [] Quote Opening F-1 Quote Award Proposal Opening C/O & PCA No. ❑ Chg. Order, No. ❑ Traffic Control Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description -,.qu fed Information Proposal Special Purchase, QPA E] Req. to Advertise 0Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach ---- ❑ Title Sheet Northern Indiana Construction _..�... ........� ........ ............................. �........ .. Yes❑ If Yes, Approved by Purchasing Z No MBE Completed E-Verify Form Attached El Yes ❑] WBE [ No East Bank Sinkhole Renairs 118-305A Streets and Alleys 226.0419.672.42.03 $83,210.75 _Project Closeout .......... For w"hq� Orders Increase $ Amount of _ �, ............... �]Decrease ($ ) Previous Amount $ Increase % Current Percent of Change: Decrease ( %) New Amount $ Increase % Total Percent of Change: Decrease ( %)mmmmm ... Time Extension Amount: New Completion Date: