HomeMy WebLinkAboutProject Completion Affidavit - Civic Alleyway Repaving Project No 118-110 - Walsh & Kelly Incii
I3I6COUNTY—1 ITYBHfLD[NG �Cr��
�i; PHONE 574/235-925I
227 W. JEFFERSON BOULEVARD,,
%J FAX 574/ 235-9I71
SOUTH BEND. INDIANA 4660I -I 830
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
August 27, 2019
Dustin Hilary
Walsh & Kelly, Inc.
24358 SR 23
South Bend, IN 46614
RE: Project Completion Affidavit — Civic Alleyway Repaving — Project No. 118-110
Dear Mr. Hilary:
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 $54,047.51.
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
sivra q 4
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS ;
PROJECT COMPLETION AFFIDAVIT"
PROJECT NAME Civic Alleyway Repaving
PROJECT NO 118-110 FINAL COST $54,047.51
CONTRACT SIGNED 12/20/2018 MAINTENANCE AGREEMENT ENDS
Mill and resurface asphalt alley, west of the South Bend Civic Theatre and Scottish Rite, from
PROJECT DESCRIPTION Madison St, north to Marion St.
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 thp contr�ctor performed the work within the scope of the Specifications and Standards of the City
of South Bend which wve1part, rf'tI above Contract.
Executed this -201v day',f 2019 Walsh & Kelly, Inc.
I've�..•�� Company Name
Signatb
Name
VP of South Bend Area
24358 SR23
Company Address
South Bend, IN 46614
City, State, Zip
WITNESSESS:
B fore me the undersigned Notary Public in and for said country and state, personally appeared
IA.isti-n Hi , and acknowledged his/her signature to the above Project Completion Affidavit on
the 2A dayf J 201 �av °�"° ALySHA KRUEGER
Notary Public. State of Indiana
�w
St. Joseph county
No Signature, t?artr1�9R?II�Srua��
d" bl 7 Q2
6/5/22
Printed Name „
County of Residence 5-�-• �J o 1�
If the Contractor is a corporation„ the following certificate will be executed.
I J. Kichael Sckut certify that I asp Secretary of the Corporation executing this cellos that
W Lin I who signed this release on behalf of the contractor W' atl4len
g ,
� ��rrrl Ar %g r12, of said Cor'porabonp that said release was duly signed for and on`t� half of said
Corrpo tiorZ�)Y,' o�riZyoll�l
r v rning body, and is within the scope of corporate power&
"w1
Secrtar dgnature �
,Corporate Seal
1. chae . Schau'tl
Printed Names
DEPARTMENT OF PUBLIC 'WORKS APPROVAL
This project is acceptable -for fin II approval and we recommend to the Board of Public Works that it be ordained so„
Date:
C t
ons ruction der
BOARD OF PUBLIC WORKS APPROVA
The ese J. D rarr, Member Laura O'Sullivan, Member
L
Maintenance Bond
That we,
Surety O + 908.903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, NJ 08889-1650
Federal Insurance Company
Bond No.8258-53-37 Amount $5,404.75
Rnow All Men By These Presents,
Walsh & Kelly, Inc.
24358 State Road 23
South Bend, IN 46614
(hereinafter called the Principal), as Principal, and the FEDERAL INSURANCE COMPANY, a corporation duly organized
under the laws of the State of Indiana, (hereinunder called the Surety), as Surety, are held and firmly bound unto
City of South Bend, Indiana, Board of Public Works
227 West Jefferson Blvd.
South Bend, IN 46601
(hereinafter called the Obligee), in the amount of Five Thousand Four Hundred Four Dollars and 75/100 ($5,404.75 ),
for the payment of which we, the said Principal and the said Surety, bind ourselves, our heirs, Sealed with our seals
and dated this 22nd day of July, 2019.
WHEREAS, the said Principal has entered into a contract dated
for: Civic Alleyway Repaving, Project No. 118-110
And
WHEREAS, the said Principal is required to guarantee the Civic Alleyway Repaving, Project No. 118-110
installed under said contract, against defects in materials or workmanship, which may develop during the
period July 22, 2019
to July 22, 2022
Form 15-02-0075FED (Rev. 5/17)
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall faithfully carry out and
perform the said guarantee, and shall, on due notice, repair and make good at its own expense any and all defects in materials
or workmanship in the said work which may develop during the period July 22, 2019 to July 22, 2022
or shall pay over, or make good and reimburse to the said Obligee all loss and damage which said Obligee may sustain
by reason or default of said Principal so to do, then this obligation shall be null and void; otherwise shall remain in full
force and effect.
Walsh & Kelly Inc.'
By
is Hilary, VP of SOuth Bend Arai
FrIlk
Federal Insurance CompanyI h
By
Attorney -in -Fact
David, M, ®liger
E
N
Form 15-02.0075M (Rev. SM
C H- U B B'
Power of Attorney
Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC
INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Lisa M. Becker, Tla A. Boice, Brian T. Morton, David M. Oliger,
Kathryn R. Postma, Tina N. Senefeld and Eric M. Wahlstrom of Indianapolis, Indiana ------------------------------------------------------------- ---------------------
each as their true and lawful Attorney -in -Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any
Instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these
presents and affixed their corporate seals on this 12" day ofJuly, 2019.
Dawn ]I Chlrrnr;.IntSect Cull y
A
STATE OF NEW JERSEY
County of Hunterdon
Slxylhen 11. Ilancy. Vice III-LNdenl
On this 12m day of July, 2019, before me, a Notary Public of New Jersey, personally came Dawn M. Chloros, to me known to be Assistant Secretary of FEDERAL INSURANCE
COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Dawn M.
Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC
INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by
authority of said Companies; and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that she is acquainted With Stephen M,
Haney, and knows him to be Vice President of said Companies; and that the signature of Stephen M. Haney, subscribed to said Power of Attorney is in the genuine handwriting of
Stephen M. Haney, and was thereto subscribed by authority of said Companies and in deponenCs presence.
Notarial Seal ROSE c
NOTARY PUBl1C OFF NEW NEW J9i4kY
*wwM 00
Cm"�60"WAV* 7L2ar!
'tiGFt,9Y� IwVAIrlka
CERTIFICATION
Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016:
"RESOLVED, that the following authorizations relate to the execution, for and on behalf of the Company, of bonds, undertakings, recognizances, contracts and other written commitments ofthe Company
entered into in the ordinary course of business (each a "Written Commitment"):
(1) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalfof the Company, under the
seal of the Company or otherwise.
(2) Each duly appointed attomey-in-fact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal ofthe Company or
otherwise, to the extent that such action Is authorized by the grant of powers provided for in such person's written appointment as such attorney -in -fact.
(3) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and on behalf of the Company, to appoint in writing any person the attorney -
In -fact of the Company with full power and authority to execute, for and on behalf of the Company, under the seal of the Company or otherwise, such Written Commitments ofthe
Company as may be specified In such written appointment, which specification may be by general type or class of Written Commitments or by specification of one or more particular
Written Commitments.
(4) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and on behalf ofthe Company, to delegate In writing to any other officer ofthe
Company the authority to execute, for and on behalf of the Company, under the Company's seal or otherwise, such Written Commitments of the Company as are specified In such
written delegation, which specification maybe by general type or class of Written Commitments or by specification of one or more particular Written Commitments.
(5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the seal ofthe Company, may be affixed by
facsimile on such Written Commitment or written appointment or delegation.
FURTHER RESOLVED, that the foregoing Resolution shall not be deemed to be an exclusive statement ofthe powers and authority of officers, employees and other persons to act for and on behalfof
the Company, and such Resolution shall not limit or otherwise affect the exercise of any such power or authority otherwise validly granted or vested."
1, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby
certify that
(I) the foregoing Resolutions adopted by the Board of Directors ofthe Companies are true, correct and in full force and effect,
(if) the foregoing Power of Attomey is true, correct and in full force and effect.
Given under my hand and seals of said Companies at Whitehouse Station, NJ, this h ly 22, 2019,
pavan }l Chlur(>-A,�,Aatlt
'IN T f E 9i ,XNaTNOU WISH TO VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER PLEASE CONTACT US AT:
f Tole Mum eB4 )RI5103,,349.1 Faxf£R'Igt,4YM-Afe.q, aq•amfl, Kurttivorliohh.f.pin
�u
II
FED- VIG-PI (rev 08-18)
Final Waiver of Lien
State oflndiana, County of St.. Joseph SS:
Dustin Hilary being duly sworn that he/she is the South Bend Area Vice President
(Name of Officer) (Title)
of Walsh & Kelly, Inc. having contracted with City of South Bend, Indiana
(Contractor) (Owner)
to furnish certain materials and/or labor as follows;
for a project known as
located at
and owned by
Civic Al
It Paving and Concrete Work
Repaving
Main Street Area, South Bend, IN
of South Bend, Indiana
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the suns of
Dollars
❑ receipt of which is hereby acknowledged; or
❑ the payment of which lies been promised as the sole consideration for this Affidavit and final Waiver of Lien: which is given
solely with respect to said asnowit, and which waiver sball be effective only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVER) that the final balance due from the contractor is the sum of 3, 3 17.38
❑ receipt of which is hereby acknowledged; or
® the payment ofwhich has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall
become offective on(y 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, famished b the undersigned
thereto, subject to limitations or conditions expressed l s and further certified that fro r party has any claim or right to a
lien on account of any work performed or material s dui ersigned for said project we scope of this Affidavit
and Waiver of Lion.
y /
Walsh & Kelly, Inc: GO qq
r Apre entail
'ft
'rn) ft oe
STATE of INDIANA ) SEAL*; n Hilary, (South Bend rea1Pce President
SS:
ST. JOSEPH COUNTY )''• .•°w""
unty and State, personally appeared Dustin Hilary
Before me, the undersigned, a Notary Pubir`# QAA
and acknowledged the execution of the foregoing Aff SPIO'MV alver omen.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my otficlal al on the 24th day of
200 19 .
l
N t� Publi Signature
My Commission Expires: June 7, 2023
Residingin Marshall h Turpin
County, Indiana 0 � Elizabeth �.
Y 400ETH TUf PIN
Notary dub ie State of Indians
Marshall County
Commission 6xpirQ6
June 7, 2024
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date-08/09/2019_...W......._____._...._--_---_____ �._..............__�.___W
Name _.........Toy Lilla
���.,.,,.. Engineering
BPW Date 08/27/2019 Phone Extension 5920
iwmwowmmmmmmmmmomamurrmmmmuwmmanwummummmiuwaur�nnwaaudw.mrrvwwrru�aNmimuwwamw!wanr aenemaenuwnwuuuww�rmromm mmmuwvmar i wmrmm��mm mm H of wavrm�
__ Required Priorwto Submittal to Board
BPW Attorney Attorney Name ...............
......... ..... .... .....____ .....__._ ........_ ......... ._............�.
Dept. Attorney 0 Attorney Name
Purchasing 1:1
Check the Appropriate Item Type -
" Professional Services Agreement LJ Contract
Open Market Contract
E]
Amendment/Addendum
[]
Bid Opening
❑
Bid Award
E] Quote Opening
❑ Quote Award
❑ Proposal Opening
❑ C/O & PCA No.
Chg. Order, No.
0 Traffic Control
R Other:
Company or Vendor Name Walsh & Kelly, Inc.
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
All Submissions
LJ Proposal
0 Special Purchase, QPA
❑ Req. to Advertise
❑ Reject Bids/Quotes
® PCA
Resolution
Ease./Encroach
Yes" If Yes, Approved by Purchasing
No
❑ Title Sheet
❑ WBE Completed E-Verify Form Attached ❑ Nos
Civic Alleyway Repaving
118-110
Complete Streets Transportation_
404.1001.460.42.30
$54,047.51
_Project
Closeout
For Change Orders Only �.... -
Amount of ❑ Increase L. _............................................. .. _..............
Decrease
Previous Amount
Increase
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e:
Current Percent of Change:
Decrease
/
New Amount
$
.........................°.°
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%
Total Percent of Change:
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Time Extension Amount:
New Completion Date: