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Home My WebLink AboutProject Completion Affidavit - Code Enforcement Door Installation - Brown and Brown1316 COUNTY -CITY BUILDING PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD �` FAX 574/ 235-9171 SOUTH BEND_ INDIANA 46601-1930 fl I CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS September 10, 2019 Eric Brown Brown & Brown General Contractors, Inc. 124 S. Elkhart Street Wakarusa, IN 46573 RE: Project Completion Affidavit — Code Enforcement Door Installation Dear Mr. Brown: 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 $3,148. 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 N CD (d N LO v co n rn o d CD' a (11 E a .X 2, W w .50 ~ z v 5 ff T o CITY OF SOUTH BEND, INDIANAVIA BOARD OF PUBLIC WORKS , PROJECT COMPLETION AFFIDAVIT PROJECT NAME Code Enforcement Door PROJECT NO. N/A �.�_. F.... ...._..__ . .m_ ......... INAL COST _$3,148 CONTRACT SIGNED 6/25/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTIO N Installation of door in Code Enforcement office 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 the r 16th day of August 20..W.19 9 . Signature Eric Brown Printed Name Brown & Brown General Contractors, Inc. Company Name _ a124.....5.. Elkhart 5t...........�_ _�....... Company Address Wakarusa, IN 46573 City/State/Zip WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally appeared Eric Brown , and acknowledged his/her signature to the above Project Completion Affidavit on the _ day of —......._A 201 9 Notary Signature _ My Commission Expires 4/3/2025 Todd A. Marek Printed Name County of Residence Marshall Co., IN If the Contractor is a corporation, the following certificate will be executed. I, Hannah M. Aitken certify that I am Secretary of the Corporation executing this release; that Eric Brown who signed this release on behalf of the contractor was then President of said Corporation; that said release was duly signed for and on behalf of said C orp ration by Authority of its governing body, and is within the scope of corporate powers: _... . Secretary's Signature Corporate Seal Hannah M. Aitken 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. all QQ Date.: G - Z 4 1 ch Cortstrtrcti n anager �. BOARD OF L. O'Sul APPROVAL David P. Relos, Member Date: c ElizabethA. Mar•adi.k, Member !r/w� Final -Waiver of Lien State oflndiana, County of Elkhart SS: Eric Brown being duly sworn that he/she is the President (Nam ofOfficer) (Title) oprown & Brown General Contractor I9c. City �i'�v g contracted withY of South Bend, IN (Contractor) (Owner) to furnishcertair: materials and/or labor as follows: additional door work (Description) for a project known as Code Enforcement (Name of Project} located at South Bend, IN and owned by City of South Bend, IN (Owner) and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: (PARTIAL WAVER) that there is due from the Contractor the suns of Dollars ❑ receipt of which is hereby acitnowledged; 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 by the undersigned; TFINAL WAIVE, that the final baler a du from t con f ree thousand one h�undr'eand -el an theT 'rs ❑ 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 reocipt of such paymenrt THEREFORE, the undersigned waives and releases unto the Owner ofsaid premises, any and all liens or claims whatsoever on the above -described property and improvemnent$ thereon an account oflabor or rnataial or both, ftnrnished b the undersigned thereto, subject to limitations or couditious expressed herein, if any-, and Rather certified drat 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 lr ' ct and wlt the scope ofthis Affidavit and Waiver of Lien. '� Brown & Brown General'Contractors, Inc. (Firm) uthori d Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared E ric B rown and aclmowledged the execution of the foregoing Affidavit and Waiver ofLien. IN WITNESS WHEREOF", I have hereunto subscribed my � nd affixed my official seat on the t 5th day of August 200 0041 �. Notes Public Signature My Commission I;•°sxpires: 4/3/2025 Todd A. Marek Resldingin Marshall county, Indiana -- odd A Mwek Notary Public SEAL Marshall County, state of Indiana Da.+bY Corn fission xpires April' ~3, 202'5 Commission Number: 698752 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 8/27/2019 Department Central Services Name Adam Parsons .... .......� ._—.—.. .... ...... ..m....., � .�� A.__....� .....w.w....�... s Division/Bureau BPW Date 9/10/2019 Phone Extension 9302�..��.�.�.r. ....................... Ic.,iwaw�ti's:�'d�� ,,, ��OANfr1k,�.�.at�-a�.'"..�I�.� '�IYd41N�Y:��VIdVW' �dtl^r—,.�'v,e,,.tiW'ild' 4�W�1�"#NI@da'�W�;�i NJi�Vf ��5u :vti�,%WYI •"°°""""°•"fiv2P '. �.�:c..a:.11M4"�+GUFN"ABIdMNNIIWI0101M!�?�4WMVVY �'._�b� ,,. 'w�m�:.,Ju� 4,.,. ._...,,.,... 1 1 ..................� ...... ........ m.. �... ..-_.,_,.,..m„�. .. ...... ,....,...._,._ uired Prior to S bmittal to Board Legal .m_.... _.. ._..w_�. g ❑ Attorney Name: Clara McDaniels Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the Agreement Amendment El Professional Services ❑ Bid Opening El Quote Opening El Change Order No. Ease/Encroach. C� Other: Company or Vendor Name 1roprtat..AeaType .:. Contract El Resolution El Bid Award F] Quote Award F] C/O &PCANo. _ FI Traffic Control: New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Brown ._B r....Gen own General --- Amount of [:] Increase $ Decrease $ Previous Amount $ for All Submissions Proposal Req. to Advertise Addendum ❑ Title Sheet