HomeMy WebLinkAboutProject Completion Affidavit - Berlin Place No 2 MEP Project No 117-048 - CBS ServicesBE
1316 COUNTY -CITY BUILDING
t� : PHONE 574/ 235-9251
227 W. JEFFERSON BOULEVARD PE.Af%
„! FAX 574/ 235-9171
'.
SOUTH BEND_ INDIANA 46601-1930 5r
a -`
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARDOF PUBLIC WORKS
September 10, 2019
Derek Allen
CBS Services, LLC
401 E. Colfax Avenue, #24
South Bend, IN 46617
RE: Project Completion Affidavit — Berlin Place No. 2 — Electrical, Mechanical, and
Plumbing —Project No. 117-048
Dear Mr. Allen:
The Board of Public Works, at its meeting held on September 10, 2019, approved the Project
Completion Affidavit for this project in the amount of $3,818,000.
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
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Berlin Place BP#2: M.E.P.
—111-1-- ...........
PROJECT NO. 117-048 W.FINALCOST $3,818,000.00
CONTRACT SIGNED June 13, 2017 MAINTENANCE AGREEMENT ENDS
J ..... . .....
PROJECT DESCRIPTIn
ON Installation of all Mechanical, Electrical and Plumbi�&.,
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.
11' uted this 421 Im day of A...........V(.,VST- 20
,
N H % CBS Serviccs..L1,.(,'
x,'% ompany Name
Si nature C
9
401 E, Colfax Ave. #24
Printed Name :=Conipany Address
-AL
4. 64 South Bend, In, 46617
City/State/Zip
WITNESSES
"n', said cotintry and state, personally
Before i e d ersigned Notary Public �A,,`d
appeared,_ and acknowledged his%er signature to the above Project Completion
day of � 201
ta Li My Commission Expires
rin.. 11 County of Residence 6a �14
If the Contractor is a corporation, the following certificate will be executed.
L - — -------- ............... certify that I am Secretary of the 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
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 is acceptable for final approval and we recommend to the Board of Public Works that it be
ordained so. 0
Date:
Constrlic' , . anage . r
BOA" OF PUBLICWO
f A . 111I{ APPROVAL
A. Giirit,
,i Prc4 ent Genevieve E. Miller, Member
v
Date
q1
4� Oi7ab�th A. Maradik,Mem'be.—r
a-ItIc, -
L. O'SulTivafi, Member rese J. 0brati, Mcniber ",--thda M. Martin,
MAINTENANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
Bond No. MNT30005210
That. CBS Service, LLC, 401 E Colfax Ave,. Suite 304, South Bend„ IN 46617
as Principal, hereinafter call Contractor, and Western Surety Com an
Chicago, IL . as Surety, hereinafter call Surety, are held and firmly bound unto
City of South Bend, Board of Public Works , as Obligee, hereinafter called Owner, in the penal sum of
$381.800.00 , for the payment whereof Contractor and Surety bind themselves, their heirs, executors,
administrators, successors, and assigns, jointly and severally, firmly by these presents.
WHEREAS, Contractor has by written agreement, dated July 13, 2017
entered into a contract with Owner for Berlin Place No. 2 -Electrical, Mecbanical & Plumbin -Division A; Project No., 1.17-048R ,
in accordance with the General Conditions, the Drawings and Specifications, which contract is by reference incorporated herein,
and made a part hereof, and is referred to as the Contract.
NOW, THEREFORE, the condition of this obligation is such that, if Contractor shall remedy any defects due to faulty materials or
workmanship, and pay for any damage to other work resulting therefrom, which shall appear within a period of three (3) year(s)
from the date of substantial completion of the work provided for in the Contract, then this obligation to be void; otherwise to
remain in full force and effect.
Bond shall be effective from July 5, 2019 to July 5, 2022.
PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable promptness.
SIGNED and sealed this 29th day of August , 2019
CBS Service, LLC
Principal
B .....Seal
Western Surety Company
(Seal)
e niter L. Kaszma
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Barbara E Pearson, Sandra L Junk, Nicole L Bicknell, Cheryl E Alkire, Megan E Riesenberg,
Mark E Wobbe, Jennifer L Kasznia, William J Cerney III, Jordan M Scheiber, Wesley
L Mantooth, Theresa M Burns, Individually
of Plymouth, IN, its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 19th day of December, 2018.
a"w WESTERN SURETY COMPANY
AF6�4 1101"qAe"I ')111
.......
. :P arrl T. Bruflat, Vice President
State of South Dakota
ss
County of Minnehaha
On this 19th day of December, 2018, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
J. MOHR
a UTH n OTA
June 23, 2021 sournrcaw amn'
--_._._...�.. . _......._�
J. Mohr,_P4o_tary Publicm
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, mid further certify dwa the By l'aw of 1he m1loralion ptintcd on 1110 rc," rya hareol s .slilfl Ill force. In leslintony whercol' I have hereunto subscribed
nay nannc atnd affixed the seat of the Said corponlik"I this .. �. day eal .
..... WESTERN SURETY COMPANY
L. Nelson, Assistant Secretary
Form F4280-7-2012
Go to www.cnasurety.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity.
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of _ ST, FUSE SS:
caw_— being duly sworn that he/she is the Acc*,
(Name of Officer) (Title)
of C65 5E2VlCE L- _c having contracted with G (ry oF- 5-v —,,v( gE N*)
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows: ELEG0-7?Z A'L
2 (Description)
for a project known as �Nt~ of PrT ?Xaun/ 1?0' C_
(Name of Project)
located at &W 500-14 66NO (IV 46401
and owned by A NDaeuv 2ozuv
(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
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Dollars($ �mm
❑ 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 is given
solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof b}' the
undersigned;
(FINAL WAIVER) that the final balance due from the contractor is the sum of
❑ 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
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.
C 0 5 5ee-✓! C E Lc.0 By
(Firm) --g'(Authorized Representative)
STATE OF INDIANA )
SS: I/ D
ST. JOSEPH COUNTY )
11L /�y l
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared
acknowledged the execution of the foregoing Affidavit and Waiver of
IN
anIN WITNESS WHEREOF, I have hereunto subscribed my name � � 1 seal on th � day of
20/
�1 S igna ure
My Commission Expires: t ✓ ,�,_� ; ` = /�
Residing in � County, � ,p�~ , ,��
'" T OF Fu Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name
09/04/2019
Toy Villa
Department: Engineering
BPW Date 09/10/2019 Phone Extension 5920
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