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HomeMy WebLinkAboutProject Completion Affidavit - East Longfellow Ave. & North Riverside Dr. Traffic Calming Proj No 118-113 - Walsh & Kelly, Inc.En 1316 COUNTY -CITY BUILDING Uf PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD IFht" FAX 574/ 235-9171 SOUTH BEND. INDIANA 46601-1 930 k" , I I365 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDF PUBLIC WORKS November 12, 2019 Mr. Dustin Hilary Walsh & Kelly, Inc. 24358 State Road 23 South Bend, IN 46614 RE: Project Completion Affidavit — East Longfellow Ave. & North Riverside Dr. Traffic Calming— Project No. 118-113 Dear Mr. Hilary: The Board of Public Works, at its meeting held on November 12, 2019, approved the Project Completion Affidavit for this project in the amount of $76,323.94. 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, x 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 64 BOARD OF PUBLIC WORKS ; PROJECT COMPLETION AFFIDAVIT PROJECT NAME E. Longfellow Ave. & N. Riverside Dr. Traffic Calming PROJECT NO 118-113 FINAL COST $76,323.94 CONTRACT SIGNED 12/20/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Install traffic calming devices along two roadways. 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 t"ractor performed the work within the scope of the Specifications and Standards of the City of South Bend which wer4'a p6t of t Lave Contract. Executed this h day October 2019 Walsh & Kelly, Inc. �"�• Company Name Sigg at 24358 State Road 23 Qus(�Hilary, VP of South Bend Area Company Address PFfnted Name South Bend, IN 46614 l� City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said Dustin Hilary and acknowledged hisd 1,#M appeared )let"son Affidavit on Notay Public, Stile of Indiana . the 28th day of Oc ref 2019 . r . "' IFAL' St. Joseph County ,. .& a i3 'm' My Cb ssion Expires 9022 Notary Signature P C" � Alisha Krueger Printed Name County of Residence St. Joseph If the Contractor is a corporation, the following certificate will be executed. I, J. Michael Schaum certify that I am Secretary of the Corporation executing this release; that Dustin Hula who signed this release on behalf of the contractor w ,th6n VP,o.f South Send Are of said Corporation; that said release was duly signed for and on" ehaij of Sao , Corporation Ib"rityofnin body, and is within the scope of corporate powers: Secretar y's ignature , aar abate Sept J. MichSchaum Printed Name ti DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for fi 1 proval and we recommend to the Board of Public Works that it be ordairw dAso. Date: Construction ' r le BOARD OF PUBLIC WORKS APPROVAL Date: A, 1A - Gary A. Gilot, President Geneve E. Miller, mbe ENlabeth A. Maradik, Member Therese J. Dorau, Member [ ,/Laura L. O'SulNiva ter " Linda M. Martin, Clerk Final Waiver of Lien State of Indiana, County of St. Joser)h SS: Dustin Hilary being duly sworn that he/she is the South Bend Area Vice President mm (Name of Officer) (Title) of .--Walsh & Kelly, Inc. having contracted with City of South Bend (Contractor) to furnish certain materials and/or labor as follows; ----.Speed Bumps . . .. .. . ........ (Description) for a project known as E._Lonqtqplc W_Ave N. Riverside Dr. Traffic Calmi , Prqjept# 118-113 . . . . . . . ... . ........... (Name of Projeot) located at E. Longfellow Avenue & N. Riverside Drive, South Bend, IN 46628 .. ............. and owned by City of South Bend, Indiana (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 E] the payment of which lies 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 34,799.44 El receipt of which is hereby acknowledged; or 91 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 sold premises, any and all liens or claims whatsoever on the above-deserlbed property and imjn ovv: Tientst vvnllrj�j ecoutit of labor or material or 1) fUrnished b the undersigned thereto, subject to limitations or conditions exp# Am] further cartTl�eVdA ho , per paly has any claim or right to a lien on account of any work performed or rn 4;*QQ, ve'rilp I proj , an IhIn the scope of this Affidavit r� qS i and Waiver ofLien. zt, ?0F1A'r,,_- Walsh& Kelly, Inc .= 14y= ... .... (Hral) ithon zed' R eprosentat No) STATE OF MIANA tin Hilary, South Bend Area Vice President SS, ST. JOSEPH COUNTY Dustin Hilary Before me, the undersigned, a Notary Pt� hid County and State, personally appeared and acknowledged the execution of the foregoing Affidevil. d Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my naand affixed my offyrlicl' It scull on the 31 st day of M October 200 i� o�y P, ub I I cS1 . gnaMm My Commission Expire,: June 7, 2023 Am Elizabeth Tur in Residing in Marshall c Indiana N rwy�,,,b County, "4_404�� PIN BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/04/2019 Department Name Toy Villa Division/Bureau Purchasing ❑ Check the Agreement Amendment Professional Services ❑ Bid Opening [� Quote Opening Q Change Order No. [l Ease/Encroach. E, Other: Company or Vendor Name Public Works Engineering )ro rite Item Type — Required for All Submissions ❑ Contract Proposal El Resolution [:] Bid Award Req. to Advertise El Quote Award F� C/O & PCA No. ® PCA F 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 Amount of El Increase Decrease Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Chanae: % Copy Original ❑ ❑ ❑ ❑ ❑ ❑ tuired Information Walsh & Kelly, Inc. Addendum ❑ Title Sheet ❑ Yes ® No ❑ If Yes, Approved by Purchasing ❑ MBE ❑ WBE No ❑ Yes Name of Company East Longfellow Avenue & North Riverside Drive Traffic Calming 118-113 LRSA _M .................. ...... ........... _ 251.0608.431.42.96 _.._....... ...... Proiect Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion„ Non -Discrimination, Non -Debarment, E-Veri!y, Iran, etc. abed For Chart .e Orders Only _._ ................................................