HomeMy WebLinkAboutPCA - Installation of Electric Vehicle Supply Equipment Proj No. 121-01 - Koontz-Wagner Services, LLC1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
March 14, 2023
Mr. Mike Dennert
Koontz -Wagner Services, LLC
3801 Voorde Dr., Suite B
South Bend, IN 46628
mdennert(kkwservices. com
RE: Project Completion Affidavit — Installation of Electric Vehicle Supply Equipment
Project No. 121-011
Dear Mr. Dennert:
At its March 14, 2023 meeting, the Board of Public Works approved the Project
Completion Affidavit for this project in the amount of $64,452.24.
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
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER
Ir
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Installation of Electronic Vehicle Supply Equipment
PROJECT NO 121-011 FINAL COST $64,452.24
CONTRACT SIGNED 7/26/2022 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Installation of EV charges are the DTSE parking garages, Century Center, and Zoo
WITNESSETH:
The work under the above contract between the Carty 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 f 5th
day of February- _, 202 3
Koontz -Wagner Services, LLC
_
Mike Dannert
°°`•�
�'��"'"' "'
Company Dame
1?an Y
Signature
3801 Voorde Dr. Suite B
Mike Dennert
State o
Notary Pu=Counly
Company Address
p �'
Printed Name
St Josep
South Bend, LN 46628
My Commission E
City, State, zip
WITNESSESS:
Before me, the undersigned Notary Public in and for said country
and state, personally appeared
"c' sVe fern
, and acknowledged his/her signature to the above Project Completion Affidavit on
the S day of VC 202 —6
.� c
Notary SignataYe My Commission Expires
._' V� e
Printed Name County of Resident¢ �]
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 goveming body, and is within the scope of corporate powers:
Secretary's Sigulture
Printed Name
Corporate Seal
DEPAWrMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so.
Date: 2/27/2023
Con uction Manager
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
M
Joseph R. Molnar, Vice President
Jordan V. Gathers, Member
Murray L. Miller, Member
Attest: Theresa M. Heffner, Clerk
Date: March 14, 2023
SEITY s acorn
Notary Puellc - Sial
Btati of lntllini
Final Waiver of Lien at Josepa county
My Commisslpn Eaplrea Jul 22. 2oT3
srata oFlndiana, cowry oY St. Joseph ss;
Mika Bannert baure aaly awern uacbNaM is dte Project Manager
p�Tama of0ffiee) (Tide)
pP Koontz Wagner Services having eonmao<ea wleh Cit of SoutM1 Bend
tcnrtra�tor) (ow er)
m fivralah wrmin ma(aaiala mar mbormfolmws: Misc_ electrical materials and EV charger
I(pmvlptloW
der a p[gjac[ kvuttm m
lecn[na at
and owvad by
EV Chargers
- (Noma ofPmJaotj
Various. locations
City of South Bend
(owmp
aad dom hemby 1btlLor smta on the bahalfoPtbn aPatom®tbmtl avboonRsatorJsuppliar:
[PARTIAL WAIVBii] dut[�ea� is duo from the Contractor the eum of
Dvllaas _($
� rewlpt oY which la hereby aclvvowladgad: or
0 the lraY +wit oP hhda bee boon promised as the solo wnehtam[ba F <hia Affidavit and P1paI Waiver ofLfwwhloh>a given
eclat]/ wide reapeot to add araowt, aad width waiver obeli ba oIffiUiva wiy upon aocaipe oPpnyaavat theraofby the
ta•deralenadt
(FINAL WAIVER) [bat [ha Enal beleaoa dna Hom doe cor[trec[or is ties anm oP
($ 3222.62 )
O reeetpt ofwhicb Ia l.mct y aalmowiaatsaa; or
® bee nee ua nR6olYva one hm been promi:ad vs the sole covsidaratiw ibr Uae Afildavi[ and I�Yuai Watvar oflAmt wbtch shad
ty vpvamcdpi ofauoh paymmat.
THEiIiBPORH, the wderaf®aad wdvae attd relamm unto dao Omer oPcaitl promiam� avy end all I(aa9 or niaima whataoaver
oa doe above -described paoparty avd impmvamavta daaraov av aaeotmt of Iabor or matarid or body fiviaiahvd b doe tmderai�ad
d:aretq aubJau to lhnita[(ova or aoaditions prmaad barely, iFavy: and Saadam mtTlfictl ShaC no od:er party hm any nidm of dghtm a
ltan on acwuat oPany work parlbrmed or material damia}tad to the undarafgned for saldp jeo[, and wldala the swipe ofdda AFTidavl[
end Wdvar oFZlen_
Koontz Wagner Services gl, MiKB BannBrt �� �"�='n'�'y"'�"' ^--�
sxAxa oP lNntnN.aF�) ) (Aathmlaea F.epreasvtadya)
) ss:
ST. JOSHPH COUNTY
Haiare ma- tlaa wdaralgned� a Notary Public, in wd !br mid County and Steta, paraonaljy appeared M - �� '�'
end aolmawladgad dta axawdw oPdaa foragoln6 AFYldavli and Waiver oYLien.
1N WiTN883 WHSItBOF� Ilaaw hareuvto aubaerlbvd tqy a atW affixed my ofY'aold aml w the ,�� dqy of
—�tebrvewa_� zoz 3 ` h Q
�` , ����_
i � - � �_ _ a
__ _ _us a as_�
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 02/27/2023
Name Kvle Ludlow Department Public Works
BPW Date 03/14/2023 Phone Extension 9157
Review and Approval Required Prior to Submittal to Board
Diversity Compliance ❑
Officer Name
and Inclusion Officer
BPW Attorney ❑ Attorney Name
Dept. Attorney ❑ Attorney Name
Purchasing ❑
Check the Appropriate Item Type — Re uired or 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
n Other: n Ease. /Encroach
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Information
Koontz Wagner Services
❑ Yes ❑ If Yes, Approved by Purchasing
® No
MBE ❑ WBE Completed E-Verify Form Attached El es
❑ No
Installation of Electric Vehicle Supply Equipment (EVSE)
121-011
210-422000; 217-422000
PR- 16949
452.24
Purpose/Description _Project Closeout
For Change Orders Only
Amount of ❑ Increase $
❑ Decrease ($ )
Previous Amount
Current Percent of Change
New Amount
Total Percent of Change:
Time Extension Amount:
New Completion Date:
Increase
Decrease ( %)
Increase
Decrease ( %1