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Home My WebLink AboutPCA - Hydrant Flow Testing Pro No. 119-041R - Shambaugh & Son, LP1316COUNTY-CITY BUILDING PHONE $74/23$-92$1 227 W. 7EFFERSON BOULEVARD "ACFAX 574/ 235-9171 SOUTH BFND_ INDIANA 46601-1 930 a CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDU LIC WORKS December 19, 2019 Mr. Cory A. Barnes Shambaugh & Son, LP 5870 Carbonmill Dr. South Bend, IN 46628 RE: Project Completion Affidavit — Hydrant Flow Testing — Project No. 119-041R Dear Mr. Barnes: The Board of Public Works, at its meeting held on December 19, 2019, approved the Project Completion Affidavit for this project in the amount of $37,145. 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 ri , BOARD OF PUBLIC WORKS, PROJECT COMPLETION AFFIDAVIT - PROJECT NAME Hydrant Flow Testing PROJECT NO 119-041R FINAL COST $37,145.00 CONTRACT SIGNED 6/25/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Flow testing and data collection of the Citv fire hvdrants. 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. E`xeotAt t is �dayof a 201 Shambau h &Son, LP Company Name Signatu 5870 Carbonmill Drive Company Address Printed Name Shambaugh & Son, L.P. South Benda IN 46628 South Bend Fire Protection Div City, State, Zip WITNESSESS: Befare me, t ie undersi ned Notary Public in and for said country and state, personally appeared and acknowledged his/her signature to the above Project the day of 201 Corey A Barnes ......._ Notary Publdc Seat State of InOana S1,fosepb County Signature ..,,�, My Commission Expires Mt tuarrtnwrssian q xpkres twttBP4 e V 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 powers: Secretary's Signature Printed Name Corporate Seal DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable +or fifixf approval and we recommend to the Board of Public Works that it be ordained so. IN ..�. ems. Date: 1. 1 Z- I Consfrlacliot tr tJer BOARD OF PUBLIC WORKS APPROVAL Date: A3��_n �Alj�k Gary A. Gilot, President Gen v E. Miller, Me bef°— i a eth A. M radik, Member ,P 7 ", JfD6rau, Member 46uh L. O'Sullivan, McFiber f in6a, M. Martin, Clerk Final Waiver of Lien State oflndiana, County of T ` SS: / being duly sworn that he/she is the (Name of Offlcer) _ (Title) of ► having contracted with City of South Bend (Contractor)fij� (Owner)to furnish certain, materials and/or labor as follows: � � � 614 J for a project known as (blame%0F,0,,J�Dx-4-/1J—r3 located at and owned by _City of South Bend (Owner) and does hereby further state on the behalf of the aforemtentioned subcont motor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of .... , Dollars ❑' receipt of which is hereby acknowledged; or El Mire payment of which has been promised as the sole consideration for this Affidavit and Final Wafer ofLlan which is given solely with respect to said amount, and which waiver sball be effective only upon receipt of payment thereofby the undersigned; h �) that t' ce due from the COrtrtfptor is the sum of r l"�Ilw1AL WAIVER) that the final balance � � �. / ❑ 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 ofsaid prernlses, any and all liens or claims whatsoever on the above -described property mid improvements thereon, au account of labor or material or both,, iitrnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and fr dbrx certified that no other party has any claim or right to n lien, on account of any work performed or material flimislted to the rtdersigned for said ro'ect, and within the scope of this Affidavit and Waiver of Lien. STATE OF BY urn INDIANA ) ) A(Autr�xad Rep,rescartatiws) SS: Mark Manninen/Branch Mgr ST, JOSEPH COUNTY ) Shambaugh 8 Son, L.P. Before me, the undersigned, a Notary Public, in and for said Countyand State aaw it care , p p .... rJt?� and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN Wl NE SS WHEREOF, I have hereunto subscribed my name and affixed my o is the day of Notary � c S aturre Corey A Bames Note Public Seal State of Indiana Publi ge e n' Joseph County My Commission Expires: a� Commission Expires 09/20/2020 Restdin in r. N Ptrlrllo 8 County, __._ �r�' Notary Home BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/05/2019 Name Ttv Villa BPW Date ------------- I Department Engineering Phone Extension 5920 l mltwetl Prior to Submittal to Board BPW Attorney Attorney Name Dept. Attorney ❑ Attorney Name Purchasing F Check the ApLpriatItem'' pe- d�ii Professional Services Agreement EJ Contract Open Market Contract ❑ Amendment/Addendum ❑ Bid Opening [❑ Bid Award �] Quote Opening Quote Award (� Proposal Opening FJ C/O & PCA No. Chg. Order, No. Traffic Control ❑, Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Required Information All Submissions " Proposal E] Special Purchase, QPA ❑ Req. to Advertise [] Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach ❑ Title Sheet Shamba�gl w& Son, LP ___________________ .-........... ❑ YcsEJ If Yes, Approved by Purchasing ® No ❑ MBE Completed E-Verify Form Attached Yes ❑ WBE No HydrantFlowTesting 119-041 .... Water _. _.............................. ............ Works Professional Services 620.0640.658.31.02 $37,145.00 Project Closeout For C hange Orders Only Amount of El Increase _w_$ Decrease �$ )....._.. .. Previous Amount $ Increase % Current Percent of Change: Decrease ( % New Amount $ Increase % .........ITIT..._..... Total Percent of Change: Decrease ( % ...............__-.________..._. Time Extension Amount: New Completion Date: