HomeMy WebLinkAboutProject Completion Affidavit - Century Center Lower Level Restroom Remodel Project No 118-082A - Brown and Brown1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOI JTH BEND. INDIANA 46601-1 Ran
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
August 27, 2019
Eric Brown
Brown & Brown General Contractors, Inc.
124 S. Elkhart St., PO Box 487
Wakarusa, IN 46573
PHONE 574/235-9251
FAx 574/235-9171
RE: Project Completion Affidavit — Century Center Lower Level Restroom Remodel —
Project No. 118-082A
Dear Mr. Brown:
The Board of Public Works, at its meeting held on August 27, 2019, approved the Project
Completion Affidavit for this project in the amount of $252,070.61.
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
m
N
N �N
g�rn
TO �a
N
2<cnn•& a- E
`Z'WYwZ'
vmco) =Cc
0 20
w2
m E E
LEEpE
�UUI
T Ip
uiWff y„
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME d tialttat Center Lower Level Rest.roorn Remodel_
�.. .. __.. w_ , . ...__ `
_._ .m.W
PROJECT NO C C 8 O A 16NAL COST s2 2 eytt tz I
CONTRACT SIGNED 1 �0� C MAINTENANCE AGfEE E I ENDSm
WITNESSETH: ---
exa. _... enter.
PROJECT DESCRIPTION Remo e o I ��te existin restroom lct�tf��on tie dower �eve�ot the Centu C _n,,,,�
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 s It d of Au ust w 2 Company Name al Contractors,
rs, Inc.
y of 9 Brown & Brown General Contracto
Signature 124 S. Elkhart St., PO Box 487
Eric Brown
Printed Name
Company Address
Wakarusa, IN 46573-0487
City, State, Zip
WITNESSESS:
Before me, the undersigned Notary Public in and for said country and state, personally appeared
—Efk,Rf r 1 _ , and acknowledged his/her signature to the above Project Completion Affidavit on
the � Wirth day of � Au us /
Notary Signature �f My Commission Expires
Todd A. Marek
Printed Name
County of Residence
4/3/2025
Marshall Co.„ Indiana
If 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
ii
Eric B !Own who signed this release on behalf of the contractor was then
IT
President of said Corporation; that said release was duly signed for and on behalf of said
Corpy ulhority of its�governing body, and is within the scope of corporate powers:
,or � ratlort
Secretary's Signala�r Corporate Seal
Hannah
M. Aitken
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
�
This project is ac ceptable r f gal approval and we recornmend to the Board of Public Works that it be ordained so.
Date
Construct! nager
M
BOARD OF PUBLIC WORKS APPROVAL Date: I f
Gary A. Gilot, President Genevieve E. Miller, Member izabet A. Maradi ember
_.
# herese J, Cgor, u, .�.
M
emt La._
ura O'Sullivan, Member ""'l.'it da M. Martin, Cler
MAINTENANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
Bond No. MNT PB02026900035
That Brown & Brown General Contractors, Inc.,. P.O. Box 487, Wakarusa, IN 46573-0487
as Principal, hereinafter call Contractor, and Philadelphia Indemnity Insurance Company
_....
Bala Cynwyd, PA as Surety, hereinafter call Surety, are held and firmly bound unto
City of South Bend Board of Public Works , as Obligee, hereinafter called Owner, in the penal sum of
$25207.06 , for the payment whereof Contractor and Surety bind themselves, their heirs, executors,
administrators, successors, and assigns, jointly and severally, firmly by these presents,
WHEREAS, Contractor has by written agreement, dated December 11, 2018
entered into a contract with Owner for CenaLij Center - Sotith Fiend Lower Level Restroom Remodel; Project No. l I8-082.A ,
in accordance with the General Conditions, the Drawings and Specifications, which contract is by reference incorporated herein,
and made a part hereof, and is referred to as the Contract.
NOW, THEREFORE, the condition of this obligation is such that, if Contractor shall remedy any defects due to faulty materials or
workmanship, and pay for any damage to other work resulting therefrom, which shall appear within a period of three (3) year(s)
from the date of substantial completion of the work provided for in the Contract, then this obligation to be void; otherwise to
remain in full force and effect.
Bond shall be effective from May 17, 2019 to May 17, 2022.
PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable promptness.
SIGNED and sealed this
7th day of Aua gust 1 2019
Brown & Brown General Contractors, Inc.
Principal
c
By (Seal)
Eric Brown, President
Philadelphia Indemnity Insurance Company
B (Seal)
J ti`er L. 'Kasarzia
u"I
504
PHMADELPIIIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004-0950
Power of Attorney
KNOW ALI. PN'RSONS 13Y I H SE PRESENTS.'Iitnt PILADELPHIA INDEMNITY INSURANCE COMPANY (tlac Company), acorporation organized and
existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint 11arbara Pears n 4o dau Sc ei e I rw, M;a,t' k
A,tWobbe. Megau HjesyjLbjcglgMegal Saandra ,Iuu The osa Burs s MAY i;ll'iam Cerfley III anti Cleat I urea ce
Agency, Inc. its 'true :and laa'wl°ul Attorney -oat -fact with Atli authaarity to cxectne on its behalf bonds, undertakings, rccogniranccs and other contracts of indcmraity
and writings obligatory in the nature thereof; issucd in the course of its business and to bind, the Company thereby, gat air amount not to exceed riQ�ftQAQ t.0Q
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14's of November, 2016.
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the
Company: (1) Appoint Attorney(s) in Fact and nuthorizv the Attorney(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attorney -in -Fact and revoke the
authority given. And, be it
FURTHER
RESOLVED: That the signatures of'such s,)I'tacos and the seal of the Company nuly be affixed to Oily
such Power of Attorney or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified by liaosimilc signatures and facsimile seal shall be
valid and binding upon the Company in the futurc with respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF, PHII,ADIiL11111A INDEMNITY INSURANCE COMPANY HAS C:°A11:51 D 1I11S 'Ill«STRUMI NT TO BE SIGNED AND ITS
CORPORATE SEALTO BE AFFDCED BY ITS AUTHORIZED OFFICE THIS 27TH DAY OF OCTOBER, 2017.
(Seal)
Robert D. O'Leary Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this 27 s day of October, 2017, before me came the individual who executed the preceding instsnaraertt, to me personally known, and being by me duly sworn said
that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is
the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed.
t' awe rwr� s�
wacxna A4
wwum{V: � Su Notary Public
do w,4", c�na
narun rwaas�nuxacsra
s�atrara�s
residing at:
(Notary Seal)
My commission expires:
Bala CX PA -------------- --
S ptcrrrober 25. 02,1
I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of
Directors and the Power of Attorney issued pursuant thereto on the 27`" day of October, 2017 are true and correct and are still in full force and effect. I do further certify
that Robert D. O'Leary Jr., who executed the Power of Attorney as President, was on the date of execution of the attached Power ofAttorney the duly elected President
of PHILADELPHIA INDEMNITY INSURANCE COMPANY.
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this day of .....Alp
.. 20 (�
1927 Edward Sayago, Corporate Secretary
PHILADE PHI'A INDEMNITY INSURANCE COMPANY
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
ALA DOCMIENT G 70 7
OWNER
ARCHITECT
CONTRACTOR
SURETY
OTHER
PROJECT: Bond Number: PB02026900035
(name, address) Century Center Lower Level Restroom Remodel; Project No. 118-082A
TO (Owner)
City of South Bend Board of Public Works ARCHITECT'S PROJECT NO:
County -City Building Room 1316 CONTRACT FOR:
South Bend, IN 46601
CONTRACT DATE: 12/11/2018
CONTRACTOR Brown & Brown General Contractors, Inc., P. O. Box 487, Wakarusa, IN 46573-0487
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert name and address of Surety Company)
Philadelphia Indemnity Insurance Company
Bala Cynwyd, PA
on bond of (here insert name and address of Contractor)
Brown & Brown General Contractors, Inc.
P. O. Box 487
Wakarusa, IN 46573-0487
,SURETY COMPANY,
,CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety
Company of any of its obligations to (here insert name and address of Owner)
City of South Bend Board of Public Works
County -City Building Room 1316
South Bend, IN 46601
as set forth in the said Surety Company's bond
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 7th
Attest: CIO::,
(Seal):
S-4869
day of August 12019
Philadelphia Indemnity.Insurance Company
Surety Company l ,,
Title
,OWNER,
Signature of Authorized Representative
Jennifer L. Kasmia
NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CON TRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS
AND CLAIMS, Current Edition
A IA DOCUMENT G707, CONSENT OF SURETY COMPANY TO FINAL PAYMENT, APRIL 1970 EDITION I AIAS ONE PAGE C
1970, THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C, 20006
91L
503
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004-0950
Power of Attorney
KNOW ALL PERSONS BY HE,SE PRFSENT& That PIII'LA.l) .A wPIIIA INDFMNITY INSURANCE COMPANY ('the Company;), a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint a a n Iordau Schelber Ie x.' Il :tMt.k
Wob4c. Nunn jilehenbere.Icol flirkpell, $and, a w u wiaeslc n a toot W4' si re III and �C:h i I ut°ance
Agency, Inc. its true and lawful Attomey4ii-fact with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity
and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed 50 000 00.0 .
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14'h of November, 2016.
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the
Company: (1) Appoint Attomey(s) in Fact and authorize the Attomey(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attomey-in-Faact and revoke the
authority given. And, be it
FURTHER
RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attomey or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS
CORPORATE SEALTO BE AFFDtED BY ITS AUTHORIZED OFFICE THIS 271x DAY OF OCTOBER, 2017.
+W,s
m _
v
r
(Seal)
Robert D. O'Leary Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this 27ie day of October, 2017, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said
that be is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is
the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed.
��daranpaa�n � ,e.
Notary Public
earau�m m+n wu Pnµ ��8/cc+wwaw
haw �ramvmap,ywa rx,m�wa#wr� as rasa '....
iwap R"'CRa'�wk V'�M.
residing at:
(Notary Seal)
My commission expires:
Balsa... Cynwydx,PA,,,,,,
Septmkterw25 2021,,,,,
I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of
Directors and the Power of Attorney issued pursuant thereto on the 27 s day of October, 2017 are true and correct and are still in full force and effect. I do further certify
that Robert D. O'Leary Jr., who executed the Power of Attorney as President, was on the date of execution of the attached Power ofAttorney the duly elected President
of PHILADELPHIA INDEMNITY INSURANCE COMPANY.
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this day of ...... ............. , 20
1927 Edward Sayago, Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY'
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of Elkhart SS:
Y„ w (Marne of Officer Wu being duly sworn that he/she is the President
Eric Brown
(Title) ..m.__�.
of Brown & wBrown General Conptractors, Inc. having contracted with City of South Bend, IN )
(Subcontractor/Suplies) ..._. _ �..._
(C«���ttcto
to furnish certain materials and/or labor as follows: complete construction
(Description)
for a project known as Century Center lower level restroom remodel
....,, _
._.m (Name of Project)
located at South Bend, IN
and owned by City of South Bend, IN_�....�.�"`.`"..._.��....._......._�..._.........�..._._._._....��,.....
(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 C.
❑ receipt of which is hereby acknowledged; or
El 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 ireceipt of payment titereof by the
undersigned;
(FINAL WAIVER) that the final balance due from the contractor is the sum of
thousand six„ n� dollars hundred tree an 53/100 ($12 603.53 ,
❑ 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 et'fkctl've 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 patty 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.
Brown & Brown General Contractors Inc
.. BY .....� ._
um (Autltctr6�ed Re resent ....�..w���..
STATE OF INDIANA ) ) p atuve)
SS:
ST. JOSEPH COUNTY )
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared
Eric Brown
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 6th day of
August200 2019
Notary Public mmSignature— —...
My Commission Expires: _ 4/3/2025
Todd A. Marek
II Indiana Residing in Marshall Not rY I 11011C NanIcrrxidAMarek
Notary Public
SEAL
Marshall County, State of Indiana
My Commission Expires April 3, 2025
Commission Number: 698752
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name I"c V1ll1
...08d�
Department Engineering
BPW Date 08/27/2019 Phone Extension 5920
mmmmorwnnww��)nna nn iwmmwiwunnrewnnrnrnrnrrtvw row N imi�.......... °.. �ui�w um
Required to Submittal to Board
::..�._�._. .._ ._ _ .......w..
BPW Attorney F] Attorney Name
Dept. Attorney Attorney Name
Purchasing ❑
.... ...... . ....... . .....
Check the ?Iygp ate I'tl � em e l kg ! (/ Lo f All Submissions
(❑ Professional Services Agreement ❑ Contract 1:1 Proposal
❑ Open Market Contract
❑ Bid Opening
] Quote Opening
E] Proposal Opening
Chg. Order, No.
Other:
❑ Amendment/Addendum E] Special Purchase, QPA
Bid Award R Req. to Advertise ❑ Title Sheet
Quote Award E] Reject Bids/Quotes
[❑ C/O & PCA No. ® PCA
❑ Traffic Control ❑ Resolution
Information
Ease./Encroach
Company or Vendor Name
Brown & Brown General Contractors, Inc.
Yes If Yes, Approved by Purchasing
New Vendor
rX] No
MBE
MBE/WBE Contractor
Completed E-Verify Form Attached ❑ No
❑' WBE
Project Name
Center Center Lower Level Restroom Remodel
Project Number
118-082A
Funding Source
Liability Insurance�
Account No.
226.0419.672.43.02
Amount
$252,070.61
Terms of Contract
Purpose/Description
Project Closeout
oseout
_...m,..
..... For mChang Orders Only __ ...
Amount of
Increase $... mmmmm ....._
�]
Decrease t$ 1
Previous Amount
$
Increase
%
Current Percent of Change:
Decrease
%
New Amount
$
Increase
/o
Total Percent of Change:
Decrease
%
Time Extension Amount:
New Completion Date: