HomeMy WebLinkAboutPCA - Fire Station Nos. 3 and 6 Abatement Proj No. 118-047A - Clean Air Environmental Services, Inc.1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
1.
186
CITY OF BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
March 10, 2020
Mr. Rick Cavinder
Clean Air Environmental Services, Inc.
64433 State Road 23
North Liberty, IN 46554
RE: Project Completion Affidavit — Fire Station Nos. 3 and 6 Abatement
Project No. 118-047A
Dear Mr. Cavinder:
PHONE 574/235-9251
FAX 574/235-9171
The Board of Public Works, at its meeting held on March 10, 2020, approved the Project
Completion Affidavit for this project in the amount of $7,900.
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 ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR
ai;�ii3dt "n
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS ",,q'
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Fire Stations 3 & 6 Abatement Quote
PROJECT NO 118-047A FINAL COST $7,900.00
CONTRACT SIGNED 1/28/2020 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Asbestos abatement on existing floors at Fire Stations 3 & 6.
WITNESSETH:
The work under the above contract between the City of South Bend and the undersigned contractor having been completed,
the City of i Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or
by suc ontract, and that the contractor performed the work within the scope of the Specifications and Standards of the City
of S ith Bend wh ch wer part of the above Contract.
E CLI this ay of 20S C ..................... Clean Air Environmental Services, I'nc,
Company Name
Signature 64433 State Road 23
Company Address
Printed Name rth Liberty, IN 46554
atiiron' LENA K IIVPSHECt
,w w r ;, r";,M NOMV Public. State of I�r 14
w 0 mtiart COWRY
WITNESSESS:fu„°" d C�pp��m��,„rtrrs tt 702883
f re e, the redesigned Notary Publlyt ,a11r sal,acr�Ar&d t 60,
r cAAand acknowledg "', I "k atgnaturewV re
the day of 201
Notary Signature / My Commission Expires
Printed Name County of Residence
State, Zip
sally appeared
Completion Affidavit on
-7[1:j J aoa-�
If the Contractor is a corporation, the following certificate will be executed. �k1
I, 446A
✓%N4 certify
that
o s gn d thist a easeary of hon behalf oo
who t
of said
on; that said
ease was dul
and on
r orati nby Au My of its governing body, and is within scope of of pore a powe t c C A` calf taf saw
Co � .7 �-
9#1--t
etary`s Ignatu F�*Seal
**.•
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This projects aoce table fo fi I approval and we recommend to the Board of Public Works that it be ordained so.
I Date:
Construction timer
.m
WORKS Date: w„® .
�� �W R OVAL
°ary A. Gilrst;° resident Jet'rl :n V. Gathers, M6hiber E tzabeth A. Marddik, Member
Ther se J. D (au, Member ° °" JOs ph R. Molnar, Member """ Linda M. Martin, Clerk
Final Waiver of Lien
State oflndisins, County of St. Joseph SS:
Rick Cavinder being duly sworn that he/she is the President
(Name of Officer) (Title)
of Clean Air Environme
ntal Services Inc. having contracted with City of South Bend
(Contractor) (Owner)
to famish certain materials and/or labor as follows; Asbestos Abatement
(Descrlpdon)
for a project known as Asbestos abatement at Fire Stations 3 & 6
(Name of Project)
located at 1605 McKinley Av & 4302 Western Av,
and owned by City of South Bend
(Owner)
and does hereby fiuther state on the behalf ofthe aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Dollars$ )..
❑ 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 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
Seven Thousand Nine Huindred $7,900 , 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 effeotive only upon receipt of such payment.
TBEREFORE, the undersigned waives and releases unto the Owner of said premises, an
claims whatsoever
on the above -described property and Improvements thereon an aerourtt of labor or material or bohed b the ndersigned
thereto, subject to limitations or conditions expressed herein, if any; and ftarthercertlfied lbatnoty has any aim o; Ight'to a
lien on account of any work perfonned or material furnished to the undersigned for said project,in thoscope f tlai fdidavit
and Waiver of Lien.
Clean Air Environmental Services, Inc. -� $ Rick Cavinder Preside v
Y
(Firm) (Authorized 1. vrmtt��
STATE OF INDIANA )
SS:
ST. JOSEP14 COUNTY ) � � (' __ � ► �
Before me, the undersigned, a Notary Public, in and for said County and Siste, personally appeared _
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my offic] s 1' on the 21 M day of
February 200 20
� W
Public Signattire
My Commission Expires,
Residing in '' � County, A _A� t n�
(/t K_ . �° I aS ke
wmr,�aar,,,a
'�ENA K H1 HER
*t'',.
tO'
Notary Pubhro Staap art India
;o .
=ZSEAL;-.
Elkhart County
Commission # 702093
* <
My Commission Expires
,"10,w"' "
Judy 17, 2025
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 02/2 /2020
Name Toy Villa Department Engineer►n
BPW Date 3/10/2020 Phone Extension 5920
Lured Prior to Submittal to Board
BPW Attorney ❑ Attorney Name
Dept. Attorney ❑ Attorney Name
Purchasing ❑
Check the A propri to Item Ty awequ
El
Professional Services Agreement] Contract
Open Market Contract
❑ Amendment/Addendum
Bid Opening
❑ Bid Award
❑
Quote Opening
❑
Quote Award
F
Proposal Opening
C/O & PCA No. 1(final)
Chg. Order, No.
Traffic Control
❑ Other:
Information
All Submissions
LJ Proposal
E] Special Purchase, QPA
Req. to Advertise
❑ Reject Bids/Quotes
® PCA
Resolution
O.Ease./Encroach
Company or Vendor Name Clean Air Environmental Services„ Inc.
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
LJ Yest If Yes, Approved by Purchasing
® No
❑ MBE Completed E-Verify Form Attached
❑ WBE
Fire Stations 3 & 6 Abatement
118*047A
Fire Professional Services / Other Professional Services
101.0901.422.31.06
$7,900.00
Closeout
For Change Orders Onl
Amount of ❑ Increase $
❑ Decrease $
--------------
Previous Amount $
Increase %
Current Percent of Change: Decrease (o °)
New Amount $
Increase %
................. ..... .._______.-_____.._ www
Total Percent of Change: Decrease (%)
Time Extension Amount:
New Completion Date:
❑ Title Sheet
❑ Yes
❑ No