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Home My WebLink AboutProject Completion Affidavit - Three Twenty at the Cascade Exterior Insulation and Finish System Project No 118-074B-R - Skyline Plastering Inc1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOI JTH BEND. INDIANA 46601-1 930 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS August 27, 2019 Peter Klyachenko Skyline Plastering, Inc. 232 Westgate Drive Carol Stream, IL 60188 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — Three Twenty at the Cascade Exterior Insulation and Finish System — Project No. 118-074B-R Dear Mr. Klyachenko: 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 $561,500. 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, r Linda M. Martin, Clerk Enclosure GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU .r^,F ly N.. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Three Twenty at the Cascade - Exterior Insulation and Finish System PROJECT NO 118-074B-R FINAL COST $561,500,00 ...�.�....._ ..... ........ __......... CONTRACT SIGNED 3/26/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Apply various exterior building finishes. 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. Exe.put his �_ day of �M 201ok� k lane Pla tern fine Company Name Si nature 232 Westgate Drive / Company Address-ITITmmmmmITITIT_.. Printed Name Carol Stream, IL 60188 City, State, Zip WITNESSESS: Beft a me, the undersigned Notary Public in and for said country and state, personally appeared Q( `, _0yQ,V\t_ _ and acknowledged his/her signature to the above Project Completion Affidavit on he day of � 2010\ Notary nature OFF10114L�+bission Exp es m _ A ........ 0 �. " LUCY KONOVALCHIK OF ILLINOIS Prir�le Name W I n, the Poll certifythat I am Secretary of th If the, Contractor Is a Corp ratio � �, a Corporation 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 Co r i Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for a pproval and we recommend to the Board of Public Works that it be ordained so. Date: Construction Ier BOARD OF P /UBLIC WORKS APPROVAL Date: A� OX�t Gary A. Gilot, President Genevieve E. Miller, Member Elizabeth A. Maradik, Member Therese J orau, 1 tuber Laura L, O'Sullivan. Member M. Martin, Clerk Final Waiver of Lien %" no\ S State ofipdiaus-, County of SS: being oftloer O �anqmf � ��: g duly sworn chat he/she is the i�� (Title) ofYw t1 ,having contracted with City of South Bend (Contractor) w (Owner) to famish certain materials and/or labor as follows: for a project known as (Name of Project) located at and owned by City of South Bend y661, (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 acluiowledged; or ❑ the payment of which has been promised as the sole consideratioo 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 receipt of payment thereof by the undersigned; � INAL WAIVER), It that the final! Mactce due om the con e ) tractor is ilia sum of ❑ receipt of which is hereby acknowledged; or ® thepaymeat 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 oivnor ofsaid promises, any and all liens or claims whatsoever on the above -described property and improvements thereon mL account of labor or material or both, f ivnished b the undersigned. thereto, snbject to limitations or conditions expressed herein:, if any, and flu llyer certified that no other party has any claim or right to a lion on account of any work performed or material fin fished to the undersigned for sold pro, jectp and within the :scope of this Affidavit and WaiverofLieu. By (Firm) \ M A (Authorized lteprescntative) ��,,el,5 ) SS: COUN I"Y Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared X O and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, Ihave hereunto subscribed my name and affixed my, official seal on the day of 11 S otary P lie 1 atzu°o My Commission Expires: Residing in _l, County, OFFICIAL SEAL LUCY KONOVALCHIK NOTARY PUBLIC - STATE OF ILLINOIS W COMMISSION EXPWS 09116/23 1 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/19/2019._....._._ .— �.�.._._..�.�......._ Department Public _.. wm Name To Villa .......Ww, w Works,........ --- BPW Date 08/27/2019 Phone Extension 5920 .mm Required Prior to Submittal to Board _........_.... _.................... ......-w. BPW Attorney F-I Attorney Name Dept. Attorney Attorney Name Purchasing ❑ Check the Appropriate Item "Fype,- Professional Services Agreement ❑ Contract Open Market Contract ❑ Amendment/Addendum ❑j Bid Opening ❑ Bid Award E Quote Opening F-1 Quote Award Proposal Opening ❑ C/O & PCA No. ❑ Chg. Order, No. ❑ Traffic Control Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information All Submissions ❑ Proposal ❑ Special Purchase, QPA EI Req. to Advertise Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach Skyline Plastcrin Inc. ❑ Yes❑ If Yes, Approved by Purchasing No ❑ MBE Completed E-Verify Form Attached ❑ WBE 320 at the Cascade — Exterior Insulation and Finish S River East TIF 429-1050-46.�.�... ...�.�... 0-42.02 ��....................................w�....uw $561,500.00 Pro'ecd t Closeout ❑ Title Sheet Fj Yes No . ... .. For ers OI ....ww._...... Change, Ordn� ...... Amount of El Increase $ „W Decrease$._._._._ Previous Amount $ Current Percent of Change: New Amount Increase % Decrease ( % Increase % Total Percent of Change: Decrease Time Extension Amount: New Completion Date: