HomeMy WebLinkAboutProject Completion Affidavit - Erskine Clubhouse Renovation Project No 116-108 - Ziolkowski ConstructionVi
1316 COUNTY -CITY BUILDING C 7,
{ PHONE 574/ 235-9251
227 W.JEFFERSON BOULEVARD
FAx 574/235-917I
SOIJTH BEND_ INDIANA 46601-1930
"
., 186 ..
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
August 27, 2019
Bill Favors
Ziolkowski Construction Inc.
4050 Ralph Jones Drive
South Bend, IN 46628
RE: Project Completion Affidavit — Erskine Clubhouse Renovation — Project No. 116-108
Dear Mr. Favors:
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 $1,101,342.
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. G[LOT 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 Erskine Clubhouse Renovation
st
PROJECT NO, 116-108 FINAL COST
CONTRACT SIGNED Au 28 l , t o . ooITITIT mmmmmm
gu , 2019 MAINTENANCE ,GkEEM 1'S"1"ENDS
PROJECT DESCRIPTION Renovation of clubhouse at Erskine Golf Course.
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 12th day of A„ ,,q , 20 19
Sig6ture
Bill Favors
Printed Name
Ziolkowski Construction
Company Name
4050 Ralph Jones Drive
Company Address
South Bend, IN 46628
�................... _......._ ..............
City/State/Zip
WITNESSES
Before me, the undersigned Notary Public in and for said country and state, personally
appeared_ Bill Favors , and acknowledged his/her signature to the above Project Completion
Affidavit on the 12th day of August , 201...........
�"� "" LYNNDVINING
No Si M Commission Expires seal
' y p ' " „_67�rYkNI( - Sfalerl Indiana
L nn D. Vining Elkhart County
- •••— y My Commission Expires Mar 6, 2025
Printed Name Count of Residence 1;1k
If the Contractor is a corporation, the following certificate will be executed.
1, , Rq,b,�zr!..A,...R.aNh.................................................... , certify that I am Secretary of the Corporation executing this release; that
Bill Fayorsw_ who signed this release on behalf of the contractor was then
President CFO of said Corporation; that said release was duly signed for and on behalf of said
oa akio by Author'of its governing body, and is within the scope of corporate powers:
....... .
r
Secretary's Signature Corporate Seal
Robert A. Bash
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: l
Constru ti anager -
BOARD OF PUBLIC W III S APPROVAL Date:
Ga1y A. G l it, President Genevieve E. Miller, Member Elizabeth A. Maradik, Member
—/.
Laura L. O'Sullivan, Member
MAINTENANCE BOND
Bond Number: 285057212
KNOW ALL MEN BY THESE PRESENTS, that we _ Ziolkowski Construction. Inc.
as Principal, (the "Principal'), and Libert Mutual Insurance Com Pan a
Corporation duly organized under the laws of Massachusetts
as Surety, (the "Surety"), are held and firmly bound unto Cut of South Bend
as Obligee (the "Obligee"), in the penal sum of One Hundred Ten Thousand One Hundred Thirt Four And No/100
Dollars ( $110 134.00 )
for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents..
WHEREAS, the Principal has by written agreement dated Jut loth 2018 entered into a
contract (the "Contract") with the Obligee for,
Erskine Clubhouse Renovation l'ro;ect No. 116-10$ South Bend Venues Parks &Arts
which contract is by reference made a part hereof.,
NOW, THEREFORE, the condition of this obligation is such that if the Principal shall remedy without cost to the
Obligee any defect which may develop during a period of 3 year(s) from the date
of completion and acceptance of the work performed under the Contract provided such defects are caused by
defective or inferior materials or workmanship, then this obligation shall be null and void; otherwise it shall be and
remain in full force and effect.
PROVIDED AND SUBJECT TO THE CONDITIONS PRECEDENT, that any claims must be presented in writing to
Liberty Mutual Insurance Cmroa art „ 175 Berkete Street Boston MA 02118
DATED as of this 14th day of Au ust 2018
Ziolkski Construction, Inc. (Seal)
WITNESS/ATTEST, Principal ow
4>,A�iSiAo"ein Name. Dill 4vrr
Title: President
Libert rn Mutual Insurance Coan (Seal)
Surety
eq
Adrienne C. Stevenson , Attorney -In -Fact
State of GA
County of Fulton SS:
On August 14, 2019 ' before me, a Notary Public in and for said County and State, residing
therein, duly commissioned and sworn, personally appeared
Adrienne C. Stevenson
known to me to be Attorney -in -Fact of Liberty Mutual Insurance Company
the corporation described in and that executed the: within and foregoing instrument, and known to me to be the person who executed
the said instrument in behalf of the said corporation, and he duly acknowledged to me that such corporation executed the same.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official sea], the day and year stated in this certificate above.
My Commission Expires 8/23/2021
Maria Concepcion Notary public
TMs
'at of Attorney Kmb the acts of those named heni and they have no majortly 10
W�.Lib bind the Company except in the manner and to the extent heroin stated,
.LT
Liberty Mutual Insufancel Company
The Ohio Casualty Insurance Company Coftficato Na 8200920-969189
SURETY West American Insurance COO any
POWER OF ATTORNEY
KWWN ALL PERSONS BY THESE PRESENTS' That 7h
Liberty Mutual tasumili'm CuM W Y is 3 corporatioir i do ly (;VaniroeNd Ou lvCd&e"rffi*a lanmsuordfMaa Selovi y In a ocrWatien duty organ M I ndw lira dews Of the State Of N ow HasnpWre, ha
Of Mmaftutb, and ViOd Ama*M manno Company Is a under07POUltounderthe taws of Me State Of larhans (heroin cal act Called the"Compenjes), pull cant to and by ouftuijy� herain set forth, does hereby ni wndttute and spipoin 1, duty QqWkzed
D.
�IWRad' xa Phv Sfrsrotr«Q PraLq�,A
ifl Of Me city —d— ATIZ-11T . —ei aq'y if VOWWiiWi�n —onenaRe—d, —1b biuo and fawflfl —aftcmay_jn_%a 1-0 jTjak9
8100AA —forand ff�J%bnthalf ii—sWe-1yand as Its ad arlddeed, Wyeaddlondertakii bonds, mcOlinbancesandoltlet Sufaty0bitai In puma ' Of these Pr0i and 11111111 be as Nodirit upon the Companies as If they him been duly signed the president and afted by the secretary Of the Camfla�os In their.. ace
perms, proper
IN WITNESS WHEREOF, ft Power of Attorney has been subscribed by an auftized officer or official of the Companies and the owpoi seals of the Companies have been allixed
therelothis 16th d13YOf Aipi , 2019 .
Liberty Mutual Insurance Company
Mau, I wNtABD The Ohio Caawly insi Corriparly,
West American insurance Company
1 12 9 1991
By:
n Alt 1A
State Of PEN NSYLVANIA
County of MONTGOMERY as
§1 thtl — 161h day of 2019 befue me, porecraIly appeared David Mi Cancy, who admowledilged fimW be Me Me Assistant Sam4ary of Lberty Mutual
COr*0oY7V0__6hice Czli� Company, and —WiRfAimerlcan lAwrOnO Company, and M bea , such, bong alhonaell so to do, execute the foregoing, insburnent for the
therein contained by *nIng on behalf (A 1119 =P18tims by 11kni a duly authoosid offiw
I
WITNESS WHEREOF, I have hereunto submitled my name and affixed my notarial east at King Of PrusSils, PaWylormts, on the day mid per first show writlen
COMMONVi OPPONNOVINANA
ar N.;;. _8-� "
wwP Tome Pualsk, Noti P_
By:
UPM IAW�aolrwra p, p,aaxxi i
pie as
This Power Of Attorney is made and elftuied pument to and by aufflafty Of the kQOwhV Sy4ews and AlAhontmOurn Of "the (X00 Casualty Insurance C rpe y, Llb WtuB
Ini Company, and West Amencan nsminb`100 Company which =OluiOrls am now In full force and ri reading as Joliow& �Or A arty
OFFICERSt Settee 12, Power Of Aftrri
Any offter or ethos dW at the Coporsban suthedzed (a Mat purpose In wrifling by ft Chairman of the President and su*d to auch Urnifatioll as 9 Ch
PFWdOflI may pra;aUi, shal appokil suo e0Woyq.,jn'f4 as Play be riemmfry to act In bi of the CO"I"O"Inion to make, exe0i WA acknOWAls th airman or #u
my and Wf undertakl4s, bi ariddisi slanti
mocighbrances and other Such subject to the rMlaboi set" in their fespectlin) Poi Ofraftimey, $hat
have 108 Power to bind Me Cbmioraton, by their sitinatirre and MW604 Of any such insburrumls, and to alisch Mi #10 asel of the ation, n 60 execute ,
to by the Secrelaq, Any powar or authodly granted 10 any representative of attorney-In'taLl under The
Irlbrumi $11181 be as t9odni as if si by ft Preskisi and aftest COW Who d W
P(OViMs Of this MWO may be revoked at arty ilms, by the Board, die Ch0mair, Ole President or by Ov officar or Ifileare qlaniN No power or sullenly,
ARTIC1.0011 '- Execution Of COnb8ft Section 6, Surety Bonds and Und"Noils, 6
Any 0101 the Company aulhoi for Mail pi 0 In Willing by the chairman or the president and subject to such fminilaition, as Ole 01`4401all Or the president M prescribe,
shall appoint such, aftomoi hect, as may be no mselry to ad In behalf of the Company to make, exaii wat acknowledge and dower as Surety any and all uldedowngs,
bonds, ir"nioli and other surety obitations. Such 0001073-la-hict sutjOd 10 the tiTnifiefiono set fall in their respective powers of 0 0 ,
Company by their signature and em*on of any such fratunslus and to atladl, thereto ft seat of tho Company, Vi so exacuted such dam y Maii have Nit power i bind the
signed by the Piftlideni and atkisted ti secr6tiary, Oustfunnaft shot be as Nadmi as if
C00c,* of 0"Itinallo" - The President of Ole eoreflsny, ai porwant to the Van Of the Cornpany, sutra es ODW M Coley,, Assistant secretary to appoint such aftemer,in-
lad as may be necessary to so on behan, Of om Company to make, execute, east, ficknonfete and deft as si Any and all wdeftngs� bonds, r"Takances; and other surety
dylgations.
Authosizzoon — Sy unaminious Consent of the Comilanys Board of Orectin, M Company mi Met ISW
Id by the Company in 000nOdOn With surety bonds, shag be valid and Wrlidtl
Company, whenever 11M,0814 upon a coffled copy of any POW of 6brMlY issuf m10 Or InechantcallY reproduced $�nature of any 81 W.retary of die
Me same force and aged as though manuraftir affixed. 9 Upon the Company with
1. Renee C. 1-18WORM 010 Undft�pklxi Assistant Sarebary, The, Ohio Casi Insurance Company, Liberty Mutual Iinsurance Cori and West Am im'un Insulai COej;mAy do
hereby codify that the 0001 Power Of SUmoy of which the 10113901111 Is a rug, true and corrad copy of Ole Power of Allorney executed by said Componlas, is in full kice and: offed and
has not been revoked I
IN TESTIMONY WHEREOF, I have hereunto sad my hand and affixed the seals of said Companies this 14th dayof_August 2019
14 IN
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AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of t osc,la SS:
R;11 Favors being duly sworn that he/she is the President & CFO
(Name of Officer) (Title) _....�
of Ziolkowsld Construction, Inc. � having contracted with Vorks Cit of South Bend, Indiana
(Subcontractor/Supplier) (CITontractor)
to furnish certain materials and/or labor as follows: onstructiotr General ,.
(Description) ._
for a project known as _,EL4jh1r C,�house Renovation Pro'ect Number 116-106
(Name of project)
located at th Bend Indiana
and owned by t a:4.of
(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 acknowledged; or
❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien winch is given
solely with respect to said amount, and which waiver shall 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
0 �asand One Hundred ";l"lt�at Four and 20/100 �110,114.20
❑ 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 only upon receipt of such payment.
THEREFORE, the undersigned waives and relcascs Unto the Owner of said premises, any and all liens or claims whatsoever
on the above -described property and iinprovements thereon an account of labor�or material or bode, furnished b the undersigned
thereto„ subj cot 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,
Ziulk9wski Construction, Inc. �(A
� ��)--*' By-thorized �Reptntativ
STATE OF INDIANA )
SS:
ST. JOSEPH COUNTY )
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared B,ll Favors
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 1�t day of
Au ust, 2019
-- 200
Notary Public Signa�
My Commission Expires: - mar S
LYNN QVINING
Residing in Elkhart County,Indiana ��� u� l'"UL seal
"rotary Public Nat Notary 0-UM-7"` a e O Rana
Elkhart County
My Commission Expires Marti, 2025
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 19
m ...
�....w
Name ITo Vi11 Department: Engineering
BPW Date 08/27/2019 Phone Extension 5920
i� w wr�rsruummmmummran� er�u�aenermmrc�!rrcnamxm rwr wuma^u�
._. _ RuiredPrior.to Submittal to Board
BPW Attorney ❑ Attorney Name
Dept. Attorney E) Attorney Name
............. ....... �w_�ww���..._..................................__........ a
Purchasing
....... Check the Ault fate Item Ty1cc�l
F Professional Services Agreement E] Contract
El Open Market Contract ❑ Amendment/Addendum
El Bid Opening ❑ Bid Award
❑ Quote Opening ❑ Quote Award
❑ Proposal Opening C/O & PCA No.
El Chg. Order, No. Traffic Control
F� Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
(bi- All Submissions
❑ Proposal
[❑ Special Purchase, QPA
EJ Req. to Advertise ❑ Title Sheet
❑ Reject Bids/Quotes
® PCA
Resolution
Ease./Encroach
ZiolkowsYeki Construction, Inc.
_._...._................_ _ m...._.....
s [:] If Yes, Approved by Purchasing
® No
❑ MBE Completed E-Verify Form Attached
❑ WBE
Erskine Clubhouse Renovation
116-108
S.S...TIF-..-..-....................................._.....................w
430.1050.460.42.02 / 405.1101.452.42.02...................
$1„101,342.00
r iect Closeout
❑ Yes
❑ No
__ _... ........ ............
__-.— __ . .
_ For Charg Orders Oh y
Amount of El Increase $
❑ Decrease$....................................m.m.m.............._....._...._...._..............................�......
Previous Amount $
Current Percent of Change:
New Amount
Total Percent of Change:
Time Extension Amount:
New Completion Date:
Increase
%
Decrease
0
........_..0.
Increase
Increase
............ �
Decrease
( %