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Home My WebLink AboutPCA - Audubon Woods, Section II Proj No. DP19-004 - Irish Rentals, LLC ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER 1316 COUNTY-CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/ 235-9251 FAX 574/ 235-9171 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS March 8, 2022 Mr. Steve Cooreman Irish Rentals, LLC 4404 Technology Dr. South Bend, IN 46628 tyler@cooreman.com RE: Project Completion Affidavit – Audubon Woods, Section II Project No. DP19-004 Dear Mr. Cooreman: At its March 8, 2022 meeting, the Board of Public Works approved the Project Completion Affidavit for this project. A copy of the Project Completion Affidavit is enclosed for your records. If you have any further questions, please call this office at (574) 235-9251. Sincerely, /s/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/lh CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME PROJECT NO FINAL COST $0.00 A G R E E M E N T S I G N E D M A I N T E N A N C E A G R E E M E N T E N D S PROJECT DESCRIPTION UWf WITNESSETH: The work under the above agreement between the City of South Bend and the undersigned owner 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 agreement, and that the owner performed the work within the scope of the Speciﬁcations and Standards of the City of South Bend which were a part of the above agreement. E x e c u t ^ t h i s I S d a y o f . S O i J f a . c o m p a n y N a m e Bcut^ this signature \ I C o m p a n y A d d r e s sA V-0C':?Y O Printed Name SnuU, tHA. la City, State. Zip WITNESSES: 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 t h e J I S d a y o f . . 2 0 ^ \ My Commission Expires f2.j n "^^7^ \ I 7 ) I ( H M a r r i e C o u n t y o f R e s i d e n c ePrinter If the owner 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: Gregory John Whmier S e c r e t a r y ' s S i g n a t u r e C N o t a r y P u W i c S e a i s t a t e o i I n d i a n a > ^ L a P o f t e C o u n t y / o o r p o r a i e b e a i Commission Number NP0724146 My Commission Expires 12/17/2027 Printed Name D E P A R T M E N T O F P U B L I C W O R K S A P P R O V A L This project is acceptable for ﬁnal approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction Manager B O A R D O F P U B L I C W O R K S A P P R O V A L D a t e : Elizabeth A. Maradik. President Jordan V. Gathers. Member Gary A. Gilot. Member Murray L. Miller, Member Joseph R. Molnar, Member Anne Fuchs, Clerk March 8, 2022 Final Waiver of Lien State of Lidiana, County of (NameofOﬁScer) (Contractor) to ilimish certain materials and/or labor as follows; for a project known as located at and owned by being duly sworn that he/she is the having contracted with (Title) nWk , U^C (Owner) O^escription) /Wf Two (Name of Project) (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/suppli^: (PARTIAL WAIVER) that there is due from the Contractor the sura of □ receipt of which is hereby acknowledged; or Dolters 113 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 paymrait diereof by the undersigned; (FINAL WAIVER) that the ﬁnal balance due from the contractor is the sum of IB^ recei\ S r r e c e i p t o f w h i c h i s h e r e b y a c k n o w l e d g e d ; o r ^ Q the payment of which has been promised as the sole consideration for this Afﬁdavit and Final Waiver of Lien which shall become effective only uponreceipt 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 improvmnents thereon an account of labor or material or bodi, ﬁirairiied b the tmdersigned thereto, subject to limitations or conditi(His e^qnessed h^eln, if any; and farﬁier certi^d that no other party has any claim or ri^t to alien on account of any wodc performed or material furnished to die undersigned ﬁ>r^^ project and within die scope of diis Afﬁdavit a n d W a i v e r o f L i e m / / ^ S T A T E O F I N D I A N A ) ) SS* ST. JOSEPH COUNTY ) Before me, the undersigned, a Notaiy Public, in and for said County and State, personally appeared 3*4-^ and acknowledged the execution of the foregoing Afﬁdavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and afﬁxed my ofﬁdai seal on ^ AJbWUtkLf/^ 20^1 /f\ t My Commission Expires; c Gregory John Whrttler d Notarv Public Seal State of Indiaoa— 7 — ^ ^ L a P ^ C o u m y —_ Ci- Cornrnission Nurnber NP07241^ CopntVAAv Commission Expires 12/17/2027 Ic Signature 'oblic Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 2/22/2022 Name: Charlotte Brach Department of Public Works – Engineering Division BPW Date: 3/8/2022 Phone Extension: 9246 Required Prior to Submittal to Board BPW Attorney X Attorney Name Dept. Attorney Attorney Name Purchasing Check the Appropriate Item Type – Required for All Submissions Professional Services Agreement Contract Proposal Open Market Contract Amendment/Addendum Special Purchase, QPA Bid Opening Bid Award Req. to Advertise Title Sheet Quote Opening Quote Award Reject Bids/Quotes Proposal Opening C/O & PCA No. PCA Chg. Order, No. Traffic Control Resolution Other: Ease./Encroach Required Information Company or Vendor Name New Vendor Yes If Yes, Approved by Purchasing No MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached Yes No Project Name Audubon Woods Section 2 Project Number DP19-004 Funding Source N/A Account No. PR/PO # N/A Amount N/A Terms of Contract N/A Special Contract Provisions N/A Purpose/Description Project completion affidavit and final acceptance for City water main constructed in Audubon Woods Section 2. For Change Orders Only Amount of Increase Decrease $ ($ ) Previous Amount $ Current Percent of Change: Increase Decrease % ( %) New Amount $ Total Percent of Change: Increase Decrease % ( %) Time Extension Amount: New Completion Date: