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HomeMy WebLinkAboutProject Completion Affidavit - 315 & 319 W. Jefferson Exterior Renovations Division A Proj No 119-064 - Slatile Roofing & Sheet Metal Co., Inc.111 1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND_ INDIANA 46601-1 Ran CITY OF •' BEND rETE BUTTIGIEG, MAY IBOARD 1 i t KS December 10, 2019 Mr. Gerald Longerot Slatile Roofing and Sheet Metal Co., Inc. 1703 S. Ironwood Dr. South Bend, IN 46613 PHONE 574/235-9251 FAx 574/235-9171 RE: Project Completion Affidavit — 315 & 319 W. Jefferson Exterior Renovations, Division A —Project No. 119-064 Dear Mr. Longerot: The Board of Public Works, at its meeting held on December 10, 2019, approved the Project Completion Affidavit for this project in the amount of $55,812. 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 i PROJECT COMPLETION AFFIDAVIT PROJECT NAME 315 & 319 W. Jefferson Exterior Renovations Division A PROJECT NO 119-064 FINAL COST $55,812.00 CONTRACT SIGNED 8/27/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION -Overly barrel roof at 315 W. Jefferson building. 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 , South Bend which were a part of the above Contract. E`9out is t, of Noveniber 201 9 Slatile Roofing and Sheet Metal Co., Inc. Company Name dgnatur 1703 S. Ironwood Dr Gerald Longerot -President Company Address Printed Name South Bend, IN 46613 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Gerald L g no2019his h g his/her r 6pf o f r��the above Project Completion Affidavit on ht Novemnl�er � N �dayof r_��hq N ary Signature i � pces 9/1/21 My miss; d� I Lou Ann Ward Printed Name `• County of Re Elkhart If the Contractor is a corporation, the following certilte wi8 " c I, Ann Longerot certify'}etary of the Corporation executing this release; that Gerald Longerot 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 tio�nl Aecre is governing body, and is within the scope of corporate powers: y"s Signa re Corporate Seal Ann Lon zero Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable foF fi I approval and we recommend to the Board of Public Works that it be ordained so. Date: 1 N' Construc i ager p° ,BOARD OF PUBLIC WORKS APPROVAL Date: i Z b° Gary A. Gilot, President Genevieve E. Miller, Member Elizabeth A. Mdradik, Member Therese J. D re w, Member Laura L. O'Sullivan, Member M. AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW a State Of Indiana, County of St. lose h SS:. Gerald' Lon erot being duly sworn states that he is the President of Slatile Roofing & Sheet Metal Co. Inc, (Subcontractor/Supplier) (Contractor) Furnish certain materials and/or labor as follows: jt' For a project known as n In I n 1 4? located at; and owed by (Owner) and does hereby further state on behalf of the aforementioned subonctractors/supplier:, PARTIAL Waiver that is due from the contractor the sum of: 0 Receipt of which is hereby acknowledged: or Ilars(_ OThe payment of which has been promised as the sole considertion ofthis Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be affective only upon receipt of payment thereof by the undersigned: (FINAL WAIVER) that the final balance due from the contractor is the s 1 of Q (� DOA 11�1 Dollars Receipt of which is hereby acknowledged; or 0The payment of which has been promised as the sole consideration for this Affidavit and Fin I Waiver of Lien which shall become effective upon receipt of such paymenat. THEREFORE, The undersigned wiaves the releases unto the Owner of the said premises, any and all lein or claim whatsoever on the above -described property and improved ments thereon on account of LABOR or matieral or both, furnished by the undersigned thereto, subject or conditions expressed herein, if any: and further certifies that no other party has a claim or right to lien on account of any work performed or material furnished to the underisgned for siad pri aid project, and within the scope of this affidavi and waiver. ,Slatile RoofinR & Sheet Metal Co. Inc. By c aCAAR (Firm) (Authorized Repres WITNESS MY HAND AND D NOTARY SEAL, this My commission Expires: 09 01 21 President CNN bylof M.SI 'M I / ) r �R �V G d n W4iI Printed: Lou Ann Ward Residing in Elkhart County BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/03/2019 _._...................._. Name Toy Villa Department Engineering BPW Date 12/10/2019 Phone Extension 5920 Required Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney Attorney Name Purchasing El Check the ADDrooriate Item Tvoe --. ❑ Professional Services Agreement ❑ Contract Open Market Contract Amendment/Addendum Bid Opening F-I Bid Award Quote Opening Quote Award Proposal Opening ❑ C/O & PCA No. Chg. Order, No. ❑ Traffic Control El Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description uired Information All Submissions L Proposal ❑ Special Purchase, QPA Req. to Advertise ❑ Reject Bids/Quotes ® PCA Resolution Ease./Encroach ❑ Title Sheet Slatile Rooling and Sheet Metal Co,, Inc _ .... .............................................. ............... El Yes El If Yes, Approved by Purchasing No MBE WBE Completed E-Verify Form Attached F] N s 315 & 319 W. Jefferson Exterior Renovations — Division A 119-064, Div. A................................................................... ........_......................_....._ RWDA TIF ................... ............. ._................ 324-1050-460-42.02 $55,812.00 ..... ...................................... Project Closeout. _._. For Change Orders Ong Amount of Increase $ ❑ Decrease �$ _�_ .................................................... Previous Amount $ _. _ ...................._ ...................M — ....... o Increase /o .................... Current Percent of Change: Decrease _%_IT�ITITITITITITmmmmmmmmmmmIT m ww New Amount $ ............. _.................. .... __.................. ....................... . Increase % XXX Total Percent of Change: Decrease _._.%mmm........ Time Extension Amount: New .Co...... on Date: .... .......... —.-..._..______...______________..