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HomeMy WebLinkAboutProject Completion Affidavit - Erskine Well Variable Frequency Drive Installation Project No 119-032 - Herrman & Goetz1316 COUNTY -CITY BUILDING r� ;� PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD 1 PEA 14 � - FAX 574/ 235-9171 s SOI ITH BEND. INDIANA 46601-1930 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDU LIC WORKS September 24, 2019 George Ernspenger Jr. Herrman & Goetz, Inc. 225 S Lafayette Blvd South Bend, IN 46601 RE: Project Completion Affidavit — Erskine Well Variable Frequency Drive Installation — Project No. 119-032 Dear Mr. Emspenger: 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 $6,175. 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 , t PROJECT COMPLETION AFFIDAVIT PROJECT NAME Erskine Well Variable Frequency Drive Installation ..... PROJECT NO. � 119-032 FINAL COST $6,175.00 _....... CONTRACT SIGNED 5/28/2019 MAINTENANCE AGREEMENT ENDS N/A PROJECT DESCRIPTION Install variable frequency drive on waterpu_ rnp in Erskine well house 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 _ day of _ I� , 20�_. �. �.. ��... ��._...�.... HermanGoetz, Inc. Signatut Company Name 225 S. Lafayette Blvd. Printed Name Company Address South Bend, IN 46601 City/State/Zip �. WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally appeared -Geaxg -E , and acknowledged his/her signature to the above Project Completion Affidavit on the L9 hday of guat .__, 201 9 rotary Sgnataa mm My Commission Expires 7 Catherine J. Gruber Printed Name µ _ County of Residence S t . Jose If the Contractor is a corporation, the following certificate will be executed. I Kathleen A. Herrm r rtif that I am Secretary of the Corporation executing this release; that George Ernsberge11 r who signed this release on behalf of the contractor was then Project Manager of said Corporation; that said release was duly signed for and on behalf of said Corporation b Autho •'ty f `ts gc verni�ng body, and is within the scope of corporate powers: Scera� K Signature Corporate Seal ��.exr..AH ....__....___ 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. Date: 7/23/2019 Project er BOARD OF PUBLIC WORKS APPROVAL Ga , Gilot, Pr id ^ t ' Genevieve E. Miller, Member Laura L. O'Sullivan, Member "1`hca•ese�01r,,1�6,tMembcr Date: 7LXWO / Elizaabcth A. Maradik, Member M. Martin„ AFFIDAVIT AND WAIVER OF LIEN X Final Partial Payment to Follow State of Indiana, County of St. Joseph SS: Whereas, the undersigned Herrman &Goetz, Inc. has been employed by _C lity of S(Llti Bend to furnish certain labor and material as follows: install a variable finequency drive on water minip for the building located at Erskine Well House and owned by City of South Bend and does hereby further state on behalf of the aforementioned subcontractor/supplier. (PARTIAL WAIVER) that there is due from the subcontractor 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 shall become effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Six Thousand One Hundred,& Seventy Five ...... _ Dollars ($6,175.00 [ ] receipt of which is hereby acknowledged; or [xxx] the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THERFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or MATERIAL or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies 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. Herrman & Goetz Service& lt�te 1 � ... Title Division Manager WITNESS MY HAND AND NOTARIAL SEAL, this 7Lh. .... day of. Au st._.__, 20,19 ww__. My Commission Expires: 7/ 13/2022 Printed: "1:11:ne J. Gruber Residing in St._Joeph County BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 09/16/'2019 Department Public Name Zach Hurst Works BPW Date 09/24/2019 Phone Extension 3057 UNmd� 5=M=555�NMWMM _...... ...�........,,,�.............._..__...,__...�.�.�.�...._.... _ ....._..�...... ..�.�.......w,w,�..............................._....____...., Required Prior to Submittal to Board ,�...- _�..........� .. __..........�_.......�_ ....... ........ . ��.....��......... .._ __...�.�.�.�...................... BPW Attorney F-1 Attorney Name Dept. Attorney [ Attorney Name Purchasing Check the A Pr9priat ,_Item YP .l - e ic Professional Serves Agreement Contract ❑ Open Market Contract ❑ Amendment/Addendum n Bid Opening ❑ Bid Award [❑ Quote Opening ❑ Quote Award E] Proposal Opening ❑ C/O & PCA No, [:] Chg. Order, No. ❑ Traffic Control El Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Naive Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of Previous Amount Current Percent of Change New Amount Total Percent of Change: Time Extension Amount: New Completion Date: equired Information /br All Submissions Proposal Special Purchase, QPA ❑ Req. to Advertise E] Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach ❑ Title Sheet Herman & Goetz, Inc. ..,..�_......ww.....w...www�_���� a ......... ....................... Yes ......._................... ❑ Q If Yes, Approved by Purchasing [❑ No EI MBE Completed E-Verify Form Attached No WBE Erskine Well VariablemFrequencv Drive Installation -.... 119-032..._..... ....w. SSDA -1050-460-42.07 $6,175.00 Project CompletionAffidavitfor the installation of a VFD at the Erskine we house alongwith SCADA integration. Orders Onl Increase Decrease Increase % Decrease ......w.............. � �,�. Inc- � ............. % Decrease .............................