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Home My WebLink AboutProject Completion Affidavit - 510 S. Main Street Building Improvements Proj No 119-084 - HC3 LLC dba St. Clair Developement1316 CouNTY-CITY BUILDING PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD �� ' ,sr FAX 574/ 235-9171 SOT ITHBEND. INDIANA46601-1930 '�°' �r CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS December 10, 2019 Ms. Debra St. Clair HC3 LLC d/b/a St. Clair Development PO Box 6114 South Bend, IN 46660 RE: Project Completion Affidavit — 510 S. Main Street Building Improvements — Project No. 119-084 Dear Ms. St. Clair: 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 $161,162.96. 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 amb ee CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS ,R PROJECT COMPLETION AFFIDAVIT PROJECT NAME 510 S. Main Street Building Improvements PROJECT NO 119-084 FINAL COST $161 162.96 CONTRACT SIGNED 9/10/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Winter improvements to the building located at 510 S. Main St. 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,t 4 day of AI-4)("m , 2011 _ HC3 LLC d/b/a St. Clair Development Company Name Signature P.O. Box 6114 -C,— / Company Address Printed Name South Bend, IN 46660 City, State, Zip WITNESSESS: Before me the undersigned Notary Public in and for said country and state, personally appeared and acknowledged his/her signature to the above Project Completion Affidavit on the t�, day of ) O �r� m6_r _, 201 9 Notary Signature I My Commission Expires L2 Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. I, 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 power NOTARY P(JISLIC . STATE OF INOIANA SEAL Secretary's Signature ANNETTE FARTHING COMMISSION NUM a S 9al MY COMMISSION EXPIRES JUKE 17, 2026 Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable f� fi I approval and we recommend to the Board of Public Works that it be ordained so. w w �� , Date: o,3 as Constructlo ger r " Gary A. GI ot„ resident herese J. D66u, 6ber BOARD OF PUBLIC WORKS APPROVAL Date: i /Z-/ ( 11 Genevieve E. Miller, Member Laura L. O'Sullivan, Member aradik, Member M. Martin, Clerk Final Waiver of Lien State ofindiana, County of SS. �� / ✓ ' being duly sworn that he/sue is the (Nam ofOfipoer) (Title) of having contracted with City of South Bend (Contractor) (Owner) to Aimish certain materials andlor labor as follows: for a project known as r- S (dame o 'raft) located at and owned by of South Bend and does hereby further state on the behalf of the aforementioned subcontraotordsuppller. (PARTIAL WAIVER) that there is due from the Contractor 1ho. am of Dollars . ❑ receipt of which is hereby aftow Bilged; or ❑ the payment of which loves boon, 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 bo e e only upon receipt ofpayment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of ❑ receipt of which is hereby admowle ed; or ® the Payment ofwhi h bas been promised as the sole consideration for 96 Affidavit and Final Waiver of Lien which shall become otTantive only upon receipt of such payrnent. b` THEREFORE, the undarsigned waives end releases unto the Omwer ofsaid promises, any and all liens or claims whatsoever on the, above -described property and improvements thereon an account of labor or material or both, AuuishW b the undenWed therato, subjeot to limitations or conditions expressed herain, if any; mid norther cartMed that no oilier party has any claim or right to a. Ron; on amunt of any work performed or material A nrishod to the undersigned for said project, and within the scope of this Affidavit and Walver ofLien. C/, C r01, t% BY (Firma)aRepresentative) STATE OF IMIANA ) SS: ST. JOSEPH COUNTY Before me, the undersigned a Notary Public, in and for said County and State personally appeared and s�cnowl � l��l a ared edged the exec ution of the foregoing Affidavit and Waiver of Lien. I IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my o ' lal seal on the �� h day of -� Z1.21.� 1+1C Pub. lc Y attn'e My Commission Nt�T'1�itY PUBLIC 'STATE Of INDIANA i"Imnc ANNETTE FgRTHINGRoalding rn Co t, tISNY IIQN U oalublit WSSION EXPRES JUNE 17, 2026 1 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/03/2019 Name Toy Villa 00q Department Engineering BPW Date 12/10/2019 Phone Extension 5920 Pf hie tai�'od Prior to Submittal to Board --- ....... _ _vvvv BPW Attorney Attorney Name Dept. Attorney Attorney Name Purchasing El Check the Appropriate Item Type — ❑I, Professional Services Agreement ❑ Contract Open Market Contract El Amendment/Addendum ❑ Bid Opening F] Bid Award Quote Opening El Quote Award Proposal Opening ❑ C/O & PCA No. n Chg. Order, No. Traffic Control Other: ----------------- Reauired Information All Submissions U Proposal F� Special Purchase, QPA Req. to Advertise E Reject Bids/Quotes ® PCA Q� Resolution Ease./Encroach ❑ Title Sheet Company or Vendor Name HC3 LLC dba St Clair DeveloPt7ient Yes If Yes, Approved by Purchasing New Vendor No MBE El es MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached Project Name 510 S Main Street Building rovements .... ........ Project Number 119-084 Funding Source EDIT / Grants & Subsidies Fund 433 Redevelopment General Account No. ..... ............ _._. 408.1001.460.39.30 / 433.1050.460.39.30 Amount$161,162.96 .�.............. ____.............._ _._.........................-. Terms of Contract PuMos%ati.on. ..... _........ .. ..�... _. Protect Closeout For Chg ITITOrders Only Amount of Increase ............ _ _ .................. ❑ Decrease ($ Previous Amount $ _._..__............_. ........ ....... Increase % Current Percent of Change: Decrease ( %) New Amount $ .............. ....... Increase % ... ........ ....._.................... Total Percent of Change: Decrease ( 0 Time Extension Amount: 0 days New Completion Date: