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Home My WebLink AboutProject Completion Affidavit - Lafayette Building Drain Replacement Project No 119-042 - Niezgodski Plumbing1316 COUNTY -CITY BUILDING kw) PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD ` `� FAX 574/ 235-9171 SOIJTH BEND_ INDIANA 46601-1 830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS August 27, 2019 Sheila Niezgodski Niezgodski Plumbing, Inc. 232 N. Mayflower Road South Bend, IN 46619 RE: Project Completion Affidavit — Lafayette Building Drain Replacement — Project No. 119-042 Dear Ms. Niezgodski: 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 $57,872.60. 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 lPrw. tF' 6f9 �.f.r:. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS�� PROJECT COMPLETION AFFIDAVIT PROJECT NAME _L2!a�retttBuilding Drain Replacement PROJECT NO 119-042 FINAL COST $57,872.60 CONTRACT SIGNED 5/14/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Replace the east and west interior roof drains1pipingi in the Lafayette Building 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 1114 day of —a i4l_wwwwwww 201 G% Niez odski Plumbing, Inc. „m Company Name Signature 232 North Mayflower Road IF' Company Address Printed Name South Bend, IN 46619 City, State, Zjo WITNESSESS: ASHLAN MACKENNA SMITH Befog me, the undersigned Notary Public in and for said country and state, personalElMyCornmission pe seai �, E 41ua _State of Indiana and acknowledged his/her signature to the above Project Coion 9fff 1,VdF';t��?a and y CC a Expires May 20, 2025 they ........,201�. re�� ' -...• `� My Commission Expires r� Printed � °a t .. d Name County of Residence If the Contractor is a corporation, the following certificate will be executed, 4 I, �%� '� .mm_r,� mmmmmmmmm certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then w .... of said Corporation; that said release was duly signed for and on behalf of said Corporation b Author'ry of its governing body, and is within the scope of corporate powers: Secretary s Si,gi ire Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptably fay final approval and we recommend to the Board of Public Works that it be ordained so. Date: Construct "r awn _. �T�eT BOARD OF PUBLIC WORKS APPROVAL Date; ) 7 d 0 ( % /�Nnt) U) Gary A. Gilot, President Therese J. Vorau, sober m Genevieve E. Miller, Member Eliza, ent A. Maradik, Member Laura L. O'Sullivan, Member M. Martin, Clerk Final Waiver of Lien State of Indiana, County of SS: " being duly sworn that he/she is the "er)ane0fC ofhaving contracted with Contractor) (Owner) to furnish certain materials and/or labor as follows; " L (Description) for a project known as L_ _."�• g'�ya, (Name €1�rojoot} located at and owned by (Ovvater} 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 Cho payment of which has been promised its the sole consideration for this Affidavit aatd Final Waiver of"Lleaa which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; 1 (FINAL WAIVER) that the fins � —1 balance due from the contractor is the sum of 1 5 ❑ receipt of which is hereby acknowledged; or the paymeut of Which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become affective only Capon receipt of such payment. 1" 1BREFORE, the undersigned waives and releases uinto the Owner ofsaid premises, any and all liens or claims whatsoever oil the above -described property and improvements thereon tut rtcco'uut of labor or material or 'both, Runishell b the undersigned thereto, subject to limitations or conditions expressed herein, if any; said 11wilyer certified that no other panty has tiny claim or right to a lien on accoaant of any work performed or material furnished to tine undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. _ ` (Firm) t w BY ._ _ sized sent i uxn ttva m . STATE OF INDIANA ) ) } SS: $ ST. JOSEPH COUNTY } Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared and aclatowlcdged the execution oftltc foregoing Affidavit and Waiver of Lien. IN WITNESS WRL �0r, I have hereuntohereuntosubscril oaQy na� me and axed yyi seal on the day of ,..., .t Publto.Signa . My Commission Expires: � • _. yr ^ � Notary Public akm e Residing in A x i Mount A E HLAN MACKENNA SMITH Seal ary Public - State of Indiana St Joseph County mmission Expires May 20, 2025 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/ 16/2019 Name TqVilla Department Enincerin �.�... ......... BPW Date 08/27/2019 Phone Extension 5920 uHiHiHuuHuuHuuuHiuiwiwiwiwuHiH ar �rmmarMttsw�„�mmmrm.�rmiimruawnn�,�.:: ��.;�,;x..................��.�ssrx�cu��ruw�rrvmaa,�i��rarvrssr.�a�uuuuuuumrr�wwmriuuuuuuuuuuumuuuuuunm�w�mrrmrvas;�au�rr� rs:�e�ays�.�.�.,�.,��.A,a�.Anaaa�.�saum�r��uu�rvmmmwmi�wwr ........... __ wired Re Prior to S — e............ .Re Submittal to Board...... ..... ...,,,�... Legal ❑ Attorney Name Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the Agreement Professional Services Bid Opening ❑ Quote Opening ❑ Change Order No. _ ❑ Ease/Encroach. El Other: Mrriate Item Type ler M Contract El Resolution ❑ Bid Award F-1 Quote Award ❑ C/O & PCA No. ❑ Traffic Control d for All Submissions U Proposal L Addendum ❑ Req. to Advertise ❑ Title Sheet Required Information Company or Vendor Name Niezgodski Plumbing, Inc. New Vendor 0 Yes ® No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE Projectto Name Lafayette Building_Dram Replacement _.. �. ....... Project Number 1 19-042 A Funding Source RWDA Account No. ............ ..... ....... ...... ,__._ .............. m. 324-1050-460-42.02 Amount $57,87. ....... ......... .......__--------...-_...................._._._._ 2.60 Terms of Contract _... .....-. ....... _... __ ... ----- ....................... .............. Purpose/Description �Project Closeout ........... ---- ---- ---_ __ __._ �. ��..�... _..................�.��.. ❑ Required Contractor's Certification Form Attached (Non - Collusion„ Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Recuired For Chanae Orders On Amount of Increase Decrease $ ..................... Previous Amount $ Current Percent of Change: % New Amount. Total Percent of Change: Dispersal After Approval Copy Original ❑ ❑