Loading...
HomeMy WebLinkAboutProject Completion Affidavit - School Zone Flashing Beacon Relocations Proj No 119-058 - Michiana Contracting, Inc.KIn S �r 1316 COUNTY -CITY BUILDING C Nr PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD may; °�'"`�'y°''6 FAx 574/ 235-9171 I'T il" 'M^ SOUTH BEND. INDIANA 46601-1 930 f lyr x 186 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDU LIC WORKS November 12, 2019 Mr. Scott Kirkpatrick Michiana Contracting, Inc. PO Box 929 Plymouth, IN 46563 RE: Project Completion Affidavit — School Zone Flashing Beacon Relocations — Project No. 119-058 Dear Mr. Kirkpatrick: 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 $9,800. 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 PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: " rtli4 WM dM CITY OF SOUTH BEND, INDIANA� BOARD OF PUBLIC WORKSy PROJECT COMPLETION AFFIDAVIT School Zone Flashing Beacon Relocations 119-058 FINAL COST $9 800.00 7/9/2019 MAINTENANCE AGREEMENT ENDS Relocation of four 4 school zone flashing beacons within the City of South Bend, IN. 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. Execu d this 30'th day ofOc Ober 2019 Michiana Contracting, Inc. Company Name Signature I PO Box 929 ® Company Address Printed Name Plymouth, IN 46563 City, State, Zip WITNESSES: Before me the undersigned Notary Public in and for said country and state, personally appeared =ott - ° trick , and acknowledged his/her signature to the above Project Completion Affidavit on the 30th day of Oct 201 9 �. ANDREA JAE ,. FISHER tary S `lg`n,`a'turV My Commission Expires _ ff ta[ „ Seal State of Indiana Printed Name County of Residence Marshall County �@ ,y�rrss�e�flirs5-�raaa-=� If the Contractor is a corporation, the following certificate will be executed. I„ Lisa Botto certify that I am Secretary of the Corporation executing this release; that Scott Kirk trick 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 Cor by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal I Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable %or fi I approval and we recommend to the Board of Public Works that it be ordained so. Pon Date: 1 D. 2 Z• l Constructi ger BOARD OF PUBLIC WORKS APPROVAL Date: / " ) 7-1 -bklf�l dz"6�s� --j U Q, Gary A. Gilot,tgresia ent Geneyre�e E. Miller erhber Elizabeth A. aradik, Member Therese J. Dorau, Member Lai.ara 'Sullivan, MrMber ,-,- i da M. Martin, Clerk Final Waiver of Lien State of Indiana, County of Marshall SS: Scott Kirkpatrick being duly sworn that he/she is the President (Name of bifi—c i (N faer of �� (Title} Michiana Contract' Inc. having contracted with DePa'�t of Public Works (Contractor) (Owner) to furnish certain materials and/or labor as follows: Flashing Beacon Relocation (Description) for a project known as School Zone Beacon Relocations (Name ofProjeot) located at City of South Bend Indiana 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 suns of Dollars ❑ receipt of which is hereby aclaiowledged; or ❑ the payment'of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lienwhich 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 Nine Thousand _ rsJl-. , 800,00 ❑ 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, flamished b the undersigned thereto,, subject to limitations or conditions expressed heroin,, 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 famished to the undersigned for sai4(Aut 'd Ithin the scope of this Affidavit and Waiver of Lien. Mich�iara t ntract ' .Inc. a� ....�.�...m..,. IIy (Firm) x cprescntative) STATE OF INDIANA ) Marshall ) SS: �, , q . M COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Scott Kirkpatrick and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. IN WITNESS WHEREOF, I have hereunto subscribed mv name and affixed my off/ also on the day of My Commission Expires: Residing in ANDREA JAE FISHER Notary Public - Seal JZLoPubliS1 1110 State of Indiana y Commis 27, 2022 _ oM >� Commission Expires Mar Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date November 5, 2019 Name Toy Villa Public Works — Eng. BPW Date November 12 2019 Phone Extension 5920 Required Prior to Submittal to Board BPW Attorney Attorney Name Dept. Attorney EJ Attorney Name Purchasing Check the Ap rya riat Item lii°d i°All Submissions Professional Services Agreement 0 Contract Proposal Open Market Contract Amendment/Addendum ❑ Special Purchase, QPA E] Bid Opening Bid Award 0 Req. to Advertise ❑ Title Sheet R Quote Opening 0 Quote Award ❑ Reject Bids/Quotes E] Proposal Opening n C/O & PCA No. ® PCA ] Chg. Order, No. E] Traffic Control ❑ Resolution Other: Ease./Encroach Required Information Company or Vendor Name Michiana Contracting, Inc. New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description El Yes ❑ If Yes, Approved by Purchasing ❑ No ❑ MBE Completed E-Verify Form Attached El Yes ❑ WBE F] No School Zone Flashin-2. Beacon Relocations 119-058 LRSA Capital 251.0608.431.42.96 ....._.__ $9.800.00 Project Closeout For Change Orders Onl Amount of Increase $ ❑ Decrease $ ) Previous Amount $ ................. _...._. Increase % ............ .--- Current Percent of Change: Decrease ............. �% New Amount $ ................w._._. Increase o /o ....._.. ....._. Total Percent of Change: Decrease Time Extension Amount: New Completion Date: ........ ............