HomeMy WebLinkAboutPCA - Fieldstone Center Utility Extension Proj No. DP21-007 - Patel LLC Hospitality Dev. Group1316 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
June 27, 2023
Mr. Hodge Patel
Patel LLC dba Hospitality Development Group
540 Still House Lane
Milton, GA 30004
hp&hodepatel.com
RE: Project Completion Affidavit — Fieldstone Center Utility Extension
Project No. DP21-007
Dear Mr. Patel:
At its June 27, 2023 meeting, the Board of Public Works approved the Project
Completion Affidavit for this project for public utility extensions.
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 Hefner
Theresa Heffner, Clerk
Enclosures
TH/lh
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER
BENJAMIN MARLATT
Notary Public
State of Indiana
Commission No. 711569
E s
My Commission xplre CITY OF SOUTH BEND, INDIANA r
March 22, 2026'�
PROJECT NAME
PROJECT NO
AGREEMENT SIGNED
PROJECT DESCRIPTION
WITNESSETH:
BOARD OF PUBLIC WORKS .# ;�
PROJECT COMPLETION AFFIDAVIT '
FINAL CO V-p Q+&
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.
Executed this Z` day of
Company Name
Signat a SVb
Company Address
Printed Name �t n�`-�CU UCy- A , �3 Oy 0�
City, State, Zip
WITNESSES:
Be1re me, the undersigned Notary Public in and for said country and state, personally appeared
.► 11 OQ V-, Q' et and acknowledged his/her signature to the above Project Completion Affidavit on
the 2&"L Py of ZoZ�
Nota re My Commission Expires `vlA C' -w 2'Z, Zouo
Printed Name County of Residence
If the owner is a corporation, the following certificate will be executed.
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:
Secretary's Signature
Corporate Seal
Printed Name
DEPARTMENT 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:
Construction Manager
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
taa 101-1rt
Elizabeth A. Maradik, President
Gary A. Gilm, Member
Murray L. Miller, Member
Joseph R. Molnar, Vice President
Jo``rrd�danV. Gathers, Member
Attest: Theresa M. Heffner, Clerk
Date: June 27, 2023
Final Waiver of Lien
State of Indiana, County of SS:
being duly sworn that he/she is the M RN ACsZ�C�
'Z c1. .LL (�C3rl 1A ld- (Title)
Of having contracted with G��� �� SON1
(Contractor) C-tLOVP (Owner)
to famish certain materials and/or labor as follows: I '3m \l(Lv's I
(Description)
for aprojectlmownas F�t�q$-teu'E C�rnct'ti Sv�O�V\S\Oil Qo��ie"'t!Jo. w?1.\.-Qa-1
(Name of Project)
located at U%(a s (X. c\3 s ov'iu, t S r4\3 \k 3'�+� A
and owned by pq^Z �� . L`.L �_ a �+uS P �—c- A�.\"'C`l e d Z Lo
(Owner)
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the aum 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 of active only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVED that the final balance due ftni the contractor is the sum of
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 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 improvements thereon as account of labor or material or both, famished b the undersigned
thereto, subject to limitations or conditions expressed herein, if any; and farther cartlfied that no other party has any claim or right to a
lien on account of any work performed or material Runished to the undersigned for said project, and wlthln the scope of this Affidavit
and Waiver of Lien. `
P�►z��, vac.- a lit la L
By _
i
(Firm) (Authorized Reproscaiativc) ;
STATE OF INDIANA
) SS:
ST. JOSEPH COUNTY _
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared K, Qixr E
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affted my official seal on the day of
M /�1 200 1023 .
1
No lgna
My Commission Expires: IMO. C4 2Z 202A,.
Residing in _ 5r -�Ok County,
eNu`Wt"tt� lug
BENJAM�NbMARLATT
Notary Public
State of Indiana
Commission No, 711569
My Commission Expires
March 22, 2026
Capitol Indemnity Corporation
1600 Aspen Commons, Middleton, W153562
MAINTENANCE BOND
Bond Number MNT-CIC1911604
KNOW ALL PERSONS BY THESE PRESENTS,
That Hospitality Development Group FIKIA Patel, LLC as Principal, (hereinafter called Principal), and
Capitol Indemnity Corporation of Wisconsin, with its Home Office in the City of Madison, Wisconsin, as Surety,
(hereinafter called Surety), are held and firmly bound unto City of South Bend as Obligee, (hereinafter called
Obligee), for the use and benefit of claimants as hereinafter provided in the amount of Thirty Thousand Six Hundred
Thirty Eight And 151100ths Dollars ($30,638.15), for the payment whereof Principal and Surety bind themselves,
their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents
WHEREAS, the Principal and Obligee entered into a written contract on the 27th day of June, 2022, for the
Maintenance of Water Main and Sanitary Sewer Extensions at Fieldstone Centre Subdivision located at 6801 State
Road 931 South Bend Indiana all in accordance with the plans and specifications prepared by Engineer and
WHEREAS, said contract provides that the Principal will furnish a bond to guarantee, for the period of three 3
year(s) after approval of the final estimate on said job, by the owner, against all defects in workmanship which may
become apparent during said period, and
WHEREAS, the said contract has been completed and was approved on June1, 2023.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that, if the Principal shall indemnify the
Obligee for all loss that the Obligee may sustain by reason of any defective workmanship which becomes apparent
during the period of three 3 year(s) from and after 1st day of June, 2023, then this obligation shall be null and void;
otherwise it shall remain in full force and effect.
Signed and sealed this 1st day of June, 2023.
In the presence of:
Hospitality Development Group FIKIA Patel, LLC
(Print Name of Principal) (Seal)
1C
{Si ature ❑ Officer of the Principal)
V" ?ta7 ;E4— , r'\ a �-4 A4z.!k(k--
(Print Name of Officer of the Principal and Title)
Capitol Indemnity Corporation
' - tenniNer
A ney in.p } J (Seal)
(Witness)
Kasznia,Attorne -in.-Fay'. _
(Print Name of Attorney -in -Fact and titfe;
SBD 010 (12-05) Copyright 2006, Capitol Transamerica Corporation Page 1 of 1
CAPITOL INDEMNITY CORPORATION
POWER OF ATTORNEY
MNT-CIC1911604
Bond Number
KNOW ALL MEN BY THESE PRESENTS, That the CAPITOL INDEMNITY CORPORATION, a corporation of the State of Wisconsin, having its
principal offices in the City of Middleton, Wisconsin, does make, constitute and appoint
--------NICOLE L. BICKNELL; THERESA BURNS; WILLIAM J. CERNEY, III; FAITH D. HUNT; SANDRA L. JUNK; JENNIFER L. KASZNIA------------ —------ —----
------ WESLEY L, MANTOOTH; BARBARA E. PEARSON; JORDAN M. SCHEIBER; LISA THOMAS; MARK E. WOBBE; PAMELA HIGGINBOTHAM-----------
its true and lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf, as surety, and as its act and deed, any and all
bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall
exceed in amount the sum of
ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED: 20,000,000.00------ ---------- —---- —------ —----- —---- -----_-
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors
of CAPITOL INDEMNITY CORPORATION at a meeting duly called and held on the 15th day of May, 2002.
"RESOLVED, that the President, Executive Vice President, Vice President, Secretary or Treasurer, acting individually or otherwise, be and they hereby
are granted the power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings,
and other writings obligatory in the nature thereof, one or more resident vice-presidents, assistant secretaries and attomey(s)-in-fact, each appointee to
have the powers and duties usual to such offices to the business of this company; the signature of such officers and seal of the Company may be affixed
to any such power of attorney or to any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile
signatures or facsimile seal shall be valid and binding upon the Company, and any such power so executed and certified by facsimile signatures and
facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking or other writing obligatory in the nature
thereof to which it is attached. Any such appointment may be revoked, for cmi9c, or without cause, by any of said officers, at any time."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts
required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation
making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to
the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner —
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation,
IN WITNESS WHEREOF, the CAPITOL INDEMNITY CORPORATION has caused these presents to be signed by its officer undersigned and its
corporate seal to be hereto affixed duly attested, this 1st day of January, 2020.
1pll{HfV
Attest: ll[IIIlllrll�jry/` CAPITOL INDEMNITY CORPORATION
�G
yr
Ryan J. Byrnes — � ,
Senior Vice President,
Chief Financial Officer and Treasurer — SE� John L. Sennott, Jr.
Chief Executive Officer and President
—���ru�.0. .!'n l.Y�*�nw`� 'y, •"'•..hecaelM�: � ti.��.`
Suzanne M. Broadbent �,���'��'�nrrrrrlulnttlW"�s,1
Assistant Secretary
STATE OF WISCONSIN
COUNTY OF DANE S.S.:
On the 1 st day of January, 2020 before me personally came John L. Sennott, Jr., to me known, who being by me duly sworn, did depose and say: that
he resides in the County of Hartford, State of Connecticut; that he is Chief Executive Officer and President of CAPITOL INDEMNITY
CORPORATION, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the
seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said corporation and that he signed his name
thereto by like order.+ul+ruuarr.
David J, Regele
r,' Notary Public, Dane Co„ WI
STATE OF WISCONSIN �s"
COUNTY OF DANE } S.S.: My Commission Is Permanent
I, the undersigned, duly elected to the office stated below, now the incumbent in CAPITOL INDEMNITY CORPORATION, a Wisconsin Corporation,
authorized to make this certificate, DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has not been
revoked; and furthermore, that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at the City of Middleton, State of Wisconsin this 1st day of June 20 23
1�µ1tlRVlyifl+lly _
SEAL;
Andrew B. Diaz-Matos
�ayp`+iaiNv'` a
+rrfrwfus+mn+'�' Senior Vice President, General Counsel and Secretary
THIS DOCUMENT HAS BEEN GENERATED FOR A SPECIFIC BOND- IF YOU HAVE ANY QUESTIONS CONCERNING THE
AUTHENTICITY OF THIS DOCUMENT CALL 900-475-4450. CIC-00A-M (Rev, 01-2020)
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: 6/12/2023
Name: Charlie Brach Department of Public Works — Engineering Division
BPW Date: 6/27/2023 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
I-1 Other: I -I Ease./Encroach
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Special Contract Provisions
Purpose/Description
Information
Patel LLC dba Hospitality Develobment Grou
❑ Yes ❑ If Yes, Approved by Purchasing
❑ No
❑ WBE Completed E-Verify Form Attached ❑ Nos
Fieldstone Center Utility Extension
DP21-007
N/A
PR4k9-# N/A
N/A
N/A
N/A
Project Completion Affidavit for the public utility extensions to serve the
Fieldstone Center Subdivision.
For Change Orders Only
Amount of ❑ Increase $
❑ Decrease ($ )
Previous Amount
Increase
Current Percent of Change:
Decrease
New Amount
$
Increase
Total Percent of Change:
Decrease
Time Extension Amount:
New Completion Date: