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Home My WebLink AboutPCA - Palais Royale Interior Painting Proj No. 119-055R - M&V Pro Services, Inc.1316 COUNTY -CITY BUILDING PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD -*� �*'} FAX 574/ 235-9171 SOUTH BEND. INDIANA 46601-1 930 " �;✓ w �'ziA CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD F PUBLIC WORKS December 19, 2019 Mr. Miguel Hernandez M&V Pro Services, Inc. 1126 W. Western Ave. South Bend, IN 46601 RE: Project Completion Affidavit — Palais Royale Interior Painting — Project No. 119-055R Dear Mr. Hernandez: 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 $34,160. 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 OFSOUTH BEND, UNDUANA BOARD 0FPUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Talais Royale Interior Painting PROJECT NO 119055R FINAL COST CONTRACT SIGNED 10/08/2019 mm|mTswAwosAGREEMENT smoG PROJECT DESCRIPTION Interior painting in the Palajs-&'� 'g Li The work under the above contract between the City of South Bend and the undersigned contractorhaving 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 ofSouth Bend which were opart ofthe above Contract. Company Name Company Address Printed Na e City, State, Zip VVITNEGGEGG: Before me, t undersigned Notary Public in and for said country and otate, personally appeared (A and acknowledged his/her signature to the above Project Completion Affidavit on ° uM Notary Signature My Commission Expires Printed Name If thp rnntractor is I. ------' County of Residence orporation, the following certificate will boexecuted. certify that | am Secretary of the Corporation executing this release; that Of A Q who signed this release onbehalf ofthe contractor was then ufsaid Corporation; that said release was duly signed for and onbehalf ofsaid i"firsgoveming bndy, and is within the scope of corporate powers: Irma Marlow Galven 1:N : El DEPARTMENT OFPUBLIC WORKS APPROVAL This nV is acceptable fo( f i approval and we recommend to the Board of Public Works that it be ordained so. Construction ?Vger BOARD OF PUBLIC WORKS APPROVAL Date: i A, A, �'v ' 1Y Gary A. Gilot, President Gene/vieve,, Miller, Memb X'Mara6ik, Member Therese J. Ddrau, Member u ivan, Mern' er I i d a M. M a rti nz�C-1).i AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of SS: being duly sworn that he/she is the Re suqq (Name of Officer) M of V f k -fM —1P having contracted with (Stibcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: PAL A for a project known as (Name located at I and owned by (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 !n., 4 —tt A eject) Dollars El receipt of which is hereby acknowledged; or El the payment of which has 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 . ....... . . . ..... El receipt of which is hereby acknowledged; or Ck 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 improvernerns thereon an account of labor or material or both, fumijiled b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and furtlier certified that no other parry has any clahn or right to lien oil account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. By —.0 (Firm) uthori presentative) STATE OF INDIANA SS: ST. JOSEPH COUNTY Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. INJITNESS WHEREOF, I have hereunto subscribed my name and affixed rn 7yffllcial sea] on the A, day of 200 120101� ly, Notary Public -§17J!Fn8-tTe MY Commission Expires: Maltv M Residingn ------- County, erne Irais �Mariela Galvan al Notary Public Seal State of Indiana St J, ep County St joseph Commission 11 M M, Coo","�', 0/16 v Coomssion Exoires 07/16/2025 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/10/2019 Department Name Toy Villa .�✓ Engineering BPW Date Z . t 9 Phone Extension 5920 Required Prior to Submittal to Board BPW Attorney �] Attorney Name Dept. Attorney Attorney Name ..................... Purchasing _.............. ❑ Professional Services Agreement r-1 Contract n Open Market Contract n Amendment/Addendum E, Bid Opening Bid Award Quote Opening ❑] Quote Award ❑ Proposal Opening ❑ C/O & PCA No. Chg. Order, No. ❑ Traffic Control Other: Required Information Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description All Submissions L j Proposal Special Purchase, QPA ❑ Req. to Advertise ❑ Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach ❑ Title Sheet M & V Pro Services, Inc. E] Yes], If Yes, Approved by Purchasing n No ❑ MBE Completed E-Verify Form Attached ❑ Yes ❑ WBE ❑ No Palais Royale Interior Painting 119-055R Historic Preservation 450 0405-453.36-01 $ 34,160.00 Project Closeout For Charge Orders Only ...�... ....__.. Amount of Increase $ 0 Decrease ($ 0 ........ ...... Previous Amount $ ___________________w_ww .._..... Increase 0% .........._..... _............ Current Percent of Change: Decrease (0%) New Amount $ ......._........ 0�.......................... �..........._ /o Increase 0 Total Percent of Changer Decrease (0%. Time Extension Amount: ........................�.... . New Completion Date: