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HomeMy WebLinkAboutProject Completion Affidavit - JMS Building Parking Lot Improvements Project No 118-003R - Milestone Fence LLC1316 COUNTY -CITY BUILDING r tv, PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD `'� �"�`� FAX 574/ 235-9171 SOUTH BEND_ INDIANA 46601-1830 lx I��mS CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS August 27, 2019 Chris Loftus Milestone Fence LLC 13399 McKinley Highway Mishawaka, IN 46545 RE: Project Completion Affidavit — JMS Building Parking Lot Improvements — Project No. 118-003R Dear Mr. Loftus: 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 $85,831. 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. G1LOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU ��hcMl ttMg ��'A CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS. PROJECT COMPLETION AFFIDAVIT PROJECT NAME JMS Building: Parking Lot Improvements PROJECT NO 118-003R FINAL COST $85,831.00 CONTRACT SIGNED 10/9/2018 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 o the above Contract. Executed this day of 201 Milestone Fence, LLC �m.. ITITIT -M Company Name psi 13399 McKmI,ey H��w an _— Company P Y Address .. � Printed Name Mishawaka, IN 46545 NY, TA � W ................_._.__ .City, State, Zip V y �t,acr WITNESSESS. r rx B f re me t e u rsigned Notary Public in and for said country and state, personally appeared nd acknowledged his/her signature to the above Project Completion Affidavit onxC the.df— day of 1201 7 �_. M11A nature_ My Commission Expires Icui Printed Name County of Residence ' I, certify that I am Secretary of the Corporation If the Contractor is a corporation, the following certificate will be executed., y y executing this release; that 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 Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name Corporate Seal DEPARTMENT OF PUBLIC WORKS APPROVAL This project acceptable ro ect is table for oA approval and we recommend to the Board of Public Works that it be ordained so„ p Date: Construction r Gary A. Gilot, President Therese J D rau, Member BOARD OF PUBLIC WORKS APPROVAL Date: I , Ne Genevieve E. Miller, Member Laura O'Sullivan, Member--°,71-inda M. Martin, Member Final Waiver of Lien State of Indiana, County of 2k SS: being duly sworn that he/she is the (Nacre of Officer) (Title) of 4 :.. having contracted with (Contractor) e IT (Owner) to furnish certain materials andlor labor as follows; for a project known as located at and owned by 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 aclmowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver ofLienwhich is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; W 1 Milt) t the final balance Ae from the contr" otor is the tau of 10.0 ��_.'+ ❑ 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 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 any claim or right to a Peen on account of any work performed or material famished to the undersigned for said project, and within the scope of this Affidavit M iverofLl n.IA BY .w (Finn) (Authorized Representative) STATE OF iNDlANA SS: � `(�1 ST. JOSEPH COUNTY Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared _&Uajk)� and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. 1"rNESS WM EOF, I have hereunto subscribed my narne and affixed my official seal on the q\C1 day of LA 200 f _ NoEy public Signature My ottuxaission , fires; ' Residing in ACounty, " Viii it 6, % Not F'ub0c, StWO of Rndlans ST, J'CSiNIH COUNTY SEAL Commission Number 705831 �`M c ofornusskm Expires BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM ate 20 2019�___�_�.W_. ..�...................... Name Toy Villa Department: Engineering BPW Date 08/27/2019 Phone Extension 5920 W o Required Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney [l Attorney Name Purchasing 1:1 Check the ❑ Professional ITServices Agreement ❑ Contract ❑ Open Market Contract Amendment/Addendum Bid Opening F-� Bid Award Quote Opening El Quote Award E Proposal Opening ❑ C/O & PCA No. ❑ Chg. Order, No. ❑ Traffic Control Other. Required Informatior Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description P.T Proposal �] Special Purchase, QPA Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach Milestone Fence LLC ❑ Yes( If Yes, Approved by Purchasing [� No MBE Completed E-Verify Form Attached ❑ Yes FIWBE ❑ No JMS Building — Parking Lot Improvements 118-003 River West TIF ..........................___ __ 324 .10503.460.42.02 10503.460.42.02 $85,831.00 Project Closeout m. ...:: .._...... _mWw _..: For, Chagg, Orders Only.... Amount of Increase $ Decrease ($ ) Previous Amount _.....� .�........� $ Increase % Current Percent of Change: Decrease(��% �6... ........_ New Amount $ -- °.............. Increase /o ...........................� _...........� Total Percent of Change: Decrease Time Extension Amount: New Completion Date: ............. _....._..............................................................m_..�A...............................__.