HomeMy WebLinkAboutProject Completion Affidavit - Century Center Site Improvements Project No 118-101 - Acorn Landscapingmayy'',.
1316 COUNTY -CITY BUILDING t G.71
PHONE 574/235-9251
227 W. JEFFERSON BOULEVARD S'E
MA
L, FAX 574/ 235-9171
SOUTH BEND_ INDIANA 46601-1930
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARDU LC WORKS
September 24, 2019
Jeff Ritschard
Acorn Landscaping LLC
3680 W. Sample Street
South Bend, IN 46619
RE: Project Completion Affidavit — Century Center Site Improvements — Project No. 118-
101
Dear Mr. Ritschard:
The Board of Public Works, at its meeting held on September 24, 2019, approved the Project
Completion Affidavit for this project in the amount of $136,280.08.
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 9,
PROJECT COMPLETION AFFIDAVIT `"'
PROJECT NAME Century Center Site Improvements
PROJECT NO 118-101 FINAL COST $136,280.08
CONTRACT SIGNED 3/26/2019 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Landscape and hardsca a improvements at Century Center
WITNESSETH:
The work under the above contract between the City of South Bend and the undersigned contractor having been completed,
the City of h Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or
t suc ontract„ ind that the contractor performed the work within the scope of the Specifications and Standards of the City
of So h Bend w ch were a part of the above Contract.
Exec tad this #Z� ay of ��%�%201 7Acorn Landscaping LLC
J1,Company Name
Signature
L I N D A J G I L R O Y 3680 W Sam le St
lP
Notary Public, State of Indiana Company Address
County
Sl. Joseph
Printed Name
: * °. cc mmissionaszstss South Bend, IN 46619
My Commission Expires
°imv�ffl'ww,�w°` August31i„20t9 I, City, State, Zip
WITNESSES&
Before me the undersigned
Notary Public in and for said country and state„ personally appeared
61"EAR �V nd acknowledged his/her signature to the above Project Completion Affidavit on
the ........ ._ day of
�
Notary Signature
My Commission Expires Op "(�,%"I'
Printed Name
County of Residence lit Ocf "
If the Contractor is a corporation, the following certificate will be executed.
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
Corporate Seal
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptablld'for bnal approval and we recommend to the Board of Public Works that it be ordained so„
Date:
Constructio ages
Gary A.Gilo, President
_
erese J. Wfbu, Member
BOARD OF PUBLIC WORKS APPROVAL
E. Miller, Me
aura O'Sullivan,
Elizabeth A. Maradik, Member
M. Martin, Cl
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of IJT "Ked 6111W SS:
being duly sworn that he/she is the
(Name of Officer)
(1`l w
�� (Title)
of having contracted with ��� c!'Od�fss ,(
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows:
(Description)
for a project known as
(Name of Project)
located at,
and owned by
(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 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 by the
undersigned;
WAIVER) that the fmal 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 rsaid
r both, furnished b the undersigned
thereto, subject to limitations or conditions expressed herein, if any; and further o other party has any claim or right to a
lien on account of any work performed or material famished to the undersignede�tg and within the scope of this Affidavit
and Waiver of Lien.
L I N DA dYGI
Niotaty Public, State o� Mrrpr�
F 1NDIANA )L7' sr. Joseph f ourbry . " .._..
SS: ,*�a,» Commission Number NP07210A.
ST. JOSEPH COUNTY
`" " 11111" ar `"'w My clulV 3t' 20 1on pires
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, I have hereunto subscribed my
name and affixed my official seal on the 40»1 day of
20gr
Notary Pubhc ignature
My Commission Expires:_~��
Residing in J'1 �('�}�/� County,
(,�_ ty,� Notary Public Name
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of Y1SS:
being duly sworn that he/she is the 3q4 we
(Name of Offi er) (Title)
of Ile L11 Z having contracted with
.1?44 &14, V trac _
(Subcont-ractor/Supp,lier) (Contractor)
to furnish certain materials and/or labor as follows:
(Description)
I
for a project known as
�7-
(Name of Project)
located at
and owned by
(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
11 receipt of which is hereby acknowledged; or
El 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;
(FINAL WAIVER) that the final balance due from the contractor is the sum of
"x
receipt of which is hereby acknowledged; or
El 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 bptl), furnished b the undersigned
11
thereto, subject to limitations or conditions expressepla? AN�' and further certified flarn' tither party has any claim or right to a
lien on account of any work performed or materi r6s ,Nersigned for s fro` t, and w' i the scope of this Affidavit
and Waiver of Lien.
C) 1.
p 0 RA r.
:By
-;Ac C011�
(Firm)
(Authorized Representative)
STATE OF 11N LJ1,ft1Nft
ST. JOSEPH COUNTY D�
Before me, the undersigned, a Notary Public, in an for id County and State, personally appeared
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITN�SS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the
�-S74
AMY ELIZABETH TLAP4
Notary Public, State of
Marshall county 7N
Commission Expres
My Commission Expires- June 71 2023
Residing in —p—N �VA2A County, 1 Notary
is Signature
� V I 6t4'
c Name
day of
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of SS:
being duly sworn that he/she is the
(Name of Officer) (Title)
of having contracted with Z�J�A " L%
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows: k
(Description)
for a project known as
�...
(Name of Project)
located at ~"
and owned by C .. 7 A �
(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 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 by 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 if'ed that no other party has iainra or right to a
lien on account of any work performed or material furnished to the undersign for s "d project, and wit a scope of this Affidavit
and Waiver of Lien.
By
(Firm)
STATE OF 1NDIANA (Authors " d Representative)
SS:
ST. JOSEPH COUNTY ) `"
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN Wl µ'NESS �-� 200yJ ythe day of
hereunto subscribed m name and affixed m :offlc'
ALICE M. Mc I dLEY
NOTARY PUBLIC - INDIANA
ST. JOSEPH COUNTY Not Public ignature
m „a My Comm. Expires 9/26I2024 !
My
................
Residing in _ County,
" '6- �
Notary Public Name _
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of 0 In
SS:
An ibg nq being duly sworn that he/she is the
(Name b,f Officer) (Title)
of Aff.,UZ,& / contracted with ,O�aving,
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows:
(Description)
for a project known as
located at
111�
A 2 G1, iyarxl"Wj;
(Name of Project)
and owned by
(Owner)
and does hereby Rather state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Dollars
11 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 I ien which is given
solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVER) that the final balance due from the contractor is the sum of
Ar�11�11 AjeegM1110
O� 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 premiscs, any and all licips or claims whatsoever
on the above described property and improvenients 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 riglit 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,
I M TIM I M M 0- IN I I ME RM. 11M, M
By
I b U11 I b I
(Authorized , presentative)
A NWANA
$S:
ST. JOSEPH COUNTY L.
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared iF-J on
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. I
A IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the day of
My Commission Expires:
IDA M*IEE-L—ER1DENO1JR
Notary Public - Seal Ns wary Public Signature
State of Indiana
St Joseph County
RksJDalWes Oct 7, 2021
Residing in County,
—Indiana --�Zotary Pu �Iic Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name ......... To Villa��������
BPW Date 9/24/2019 5920
_.......... ....................
...___.___....����..�Required Prior to Si'//
BPW Attorney ,❑ Attorney Name
Dept. Attorney Attorney Name
Purchasing
Check the Appr:ovr ate Item Type — Raqto
El Professional Services Agreement ❑j Contract
Open Market Contract 0 Amendment/Addendum
R Bid Opening F-1 Bid Award
❑ Quote Opening ❑ Quote Award
❑ Proposal Opening C/O & PCA No.
Chg. Order, No. El Traffic Control
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Pr t Closeout.
Information
All Submissions
Proposal
Special Purchase, QPA
Req. to Advertise
E] Reject Bids/Quotes
Z PCA
E] Resolution
Ease./Encroach
❑ Title Sheet
For Chute Orders Only
Amount of
_.... _..A_ _._.... _. ,_ ....._
�] Increase $ ......
Decrease �$
Previous Amount $
Current Percent of Change:
New Amount
Total Percent of Change:
Time Extension Amount:
New Comnletion Date:
Increase %
Decrease
......Increase .......................................
Decrease ._A ...............�.�.�%