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Home My WebLink AboutPCA - Bendix Theater Flooring Proj No. 119-106 - Carpet Service Outlet, Inc1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF • BEND JAMES MUELLER, MAYOR BOARD iWORKS March 24, 2020 Ms. Vicki Shepard Carpet Service Outlet, Inc. 1514 Mishawaka Ave. South Bend, IN 46615 PHONE 574/235-9251 FAX 574/235-9171 RE: Project Completion Affidavit — Bendix Theater Flooring — Project No. 119-106 Dear Ms. Shepard: The Board of Public Works, at its meeting held on March 24, 2020, approved the Project Completion Affidavit for this project in the amount of $72,642. 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, Yea Linda M. Martin, Clerk Enclosure GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR CITY OF SOUTH BEND, INDIANA um, BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT a" PROJECT NAME Bendix Theater Flooring PROJECT NO 119-106 FINAL COST $72 642.00 CONTRACT SIGNED 12/10/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Remove existinq and install new flooring in Bendix Theater 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 this day of 20" " Carpet Service Outlet, Inc. Company Name Signature 1514 Mishawaka Ave,: Printed Name S MOLLY A ASHERMAN Notary Public Seal. St Joseph County - State of ln4ana WITNESSES& CrmMossion N,umber NP07t7fl35 My prr Miss a Ex Ire J ra g 2 A3 fore tt a undersigned Notary urtt nd sttE " and acknowNedge NoslNaer signa acre e a ve th ay of 201�0 Nota gnature My Commission Expires MoLL,1/KWEWAN Printed Name County of Residence Company Address South Bend, IN 46615 City, State, Zip personally appeared Project Completion Affidavit on 0 ani If the Contractor is a corporation, the following certificate will be executed, N„ W certify that I am Secretary of the Corporation executing this release; that 'v'( 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 Corporati n by Autf rNly of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal h_NJ Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable f N I approval and we recommend to the Board of Public Works that it be ordained so. Date: 3 Construe ' nager BOARD OF PUBLIC WORKS APPROVAL Date* a-�� Gary A. GNlot, President Jordan Gathers wabt A. aradNk, Member Therese J. Dorau, Member Joseph Molnar M. Martin, Clerk Final Waiver of Lien State of Indiana, County of SS: 5 being duly swornthat he/she is the (Name of" cer) (Title) of having Contracted with -Ae �(Contractor)� (Owner) to furnish certain materials and/or labor as follows; . ..... . (Description) for a project known as located at and owned by 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 Dollars El receipt Of which is hereby a6l"Mledged; or ❑ 1110 PaYmcnt otwh1uh has been promised as the Role consideration for this Affidavit and Filial Waiver OfLiell which is given Solely With respect to said amount, and which Waiver shall be effective oni undersigned, Y Upon receipt Of payment thereof by tile JFINAL WAIV R) that the final balance clue from the contr4at r is the P sum of ev ❑receipt of which is hereby acknowledged; or �v ,the paynient of which has been promised as the sole coasideration for this Affidavit and Final Waiver of Lien which shall ecome effective only upon receipt of such parnont. THEREFORE, time Undersigned waives and releases unto the Owner ofsald premises, ally and all liens or claims Whatsoever oil 410 above -described Property and improvements thcteOu an account oflabor or material or both, furnished b the undersigned thereto, sUbicot to 11i'llitations Or conditions expressed herein, if say; avid further certified that no other party has tiny claim or right to a )ICA On account ofany work performed or material Airuished to the undersigned for stildproject, and whhIn the Scope of this Afridavft arid Waiver ofUen. MOLLY"SHE ,a ( Uthol -Mate of Indiana 783 Sta Po 5 Jan 9, 2027 (Firni) Notary PUbl STATE OF MDIANA St Joseph County - St e of India I ( uthor Commission Number NP0717835 My Commission Expires Jan 9, 2027 ST, JOSEPH COUNI'Y 13601`0 me, the undersigned, a Notary Public, In and for said Countyand State, Personally appeared and aolgiowledged the execution of the foregoing Affidavit and Waiver of Lion. IN wrr Niss W'HEREOF, I have h0r0untOSUbscribed my name and affixed my offic"IrW: 200 My Commission Expires., --�A N1 4o—A --- Residing in &Aokpa— County, -JNQjNk___ � h )'. ILK LaE M W) /A Cl-b- day of -t61+1:---P,MAN BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 03/16/2020 Name Toy Villa ✓ Department Engineering BPW Date 03/24/2020 Phone Extension 5920 _.._ egui eel Prior to Submittal to Board BPW Attorney Attorney Name Dept. Attorney Attorney Name Purchasing Check the Professional Services Agreement Open Market Contract H Bid Opening Quote Opening F Proposal Opening ❑ Chg. Order, No. ❑ Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description to Item.. ye Contract El Amendment/Addendum Bid Award 0 Quote Award [] C/O & PCA No. ❑ Traffic Control Information All Submissions Proposal E] Special Purchase, QPA Q Req. to Advertise ❑ Reject Bids/Quotes ® PCA Resolution Ease./Encroach ❑ Title Sheet Cam rvice Outlet Inc. ❑ Yesm If Yes, Approved by Purchasing No MBE Completed E-Verify Form Attached ❑ Yes (J WBE ❑ No Bendix Theater Flooring . . ....................._....�w_w 119-106 Hotel Motel Tax Fund 7304.42010.000.0099 $72,642.00 Project Closeout For Clhaq Orders Only ....... Amount of .._._ Increase _.$._. _ ... ...... (�Decrease ($ ) Previous Amount $ ....._........... _.....a.a. ....w Increase % ..... Current Percent of Change: ...... ........ _..... Decrease ( % o) New Amount $ Increase % �._�_��........... �_... Total Percent of Change: ........... Decrease Time Extension Amount: New Completion Date: