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Home My WebLink AboutPCA - Muessel Grove Public Restrooms Proj No. 118-099R2 - Gibson-Lewis, 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 JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS July 25, 2023 Mr. Robert A. Lingenfelter Gibson -Lewis, LLC 1001 W. 111h St. Mishawaka, IN 46544 GHickskgl.nceusa. com RE: Project Completion Affidavit — Muessel Grove Public Restrooms Project No. 118-099R2 Dear Mr. Lingenfelter: At its July 25, 2023 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $416,803. 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 CITY OF SOUTH BEND, INDIANA v `; BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Muessel Grove Public Restroom PROJECT NO 118-099R2 FINAL COST $416,803.00 CONTRACT SIGNED 9/13/2022 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION 1►iva9041*34A9:I 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. Exer,uted this 27th day of June 2n 91 Gibson -Lewis LLC Signature Robert A. Lingenfelter, President Printed Name Company Name 1001 W. 11 th St. Company Address Mishawaka, IN 46544 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Robert A. Lin enfelter , and acknowledged his/ signature to the above Pro ect Completion Affidavit on t e 27th day of June 20 23s,►T or,,� JULI HODOWANIEC y Notary Public, State of Indiana :reua; St Joseph County a =*: .4� SEAL,: : Commission M 671269 N❑ ry Signature ^'•, ; fmiAMOW20ni'es August 5, 2023 ...�• uli Hodowaniec _ Printed Name County of Residence St. Joseph 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 governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name Corporate Seal 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: 7/6/2023 Coffitruction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Vice President Ae Jordan V. Gathers, Member Y' /� Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: July 25, 2023 State of Indiana, County of Robert A. Lingenfelter (Name of Officer) of _ _Gibson -Lewis, LLC (Contractor) to furnish certain materials and/or labor as follows: for a project ]mown as located at and owned by Final Waiver of Lien St. Joseph being duly sworn that he/she is the SS: President (Title) having contracted with City of South Bend, Board of Public Works (Owner) General Construction (Description) --.� Muessel Grove Public Restroom (Nam of Project) 1222 Wilber Street, South Bend IN Citv of South Bend, Board of Public Works —. - and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (R�. i$C�{iK►i(l�}}C9�IK ��'ACC:�f'Idh�#S�C�It}Glh(a�t�i'iilCil��of — - _ Dollars $ ❑ receipt of which is hereby acluxowledged; 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 wbicla waiver sball be ef#ective only upon receipt ofpayment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Twenty Eight Thousand Five Hundred Thirty Six Dollars and 11/100 $2$ 536.11 ❑ receipt of which is hereby acknowledged; or ® thepaymeat of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become offective OHIy upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner ofsaid premises, any and all liens or claims whatsoever on the above -described property and improvements thereon au account of labor or material or bath, furnished b the undersigned thereto, subject to limitstions or conditions expressed herein, if auy; and "her certified that no other party has any claim or right to it Hen on account of any worts performed or material Mrnished to the undersigned for said project, and wlthin the scope of this Affidavit and Waiver ofLien. Gibson -Lewis, LLC' By 'M (Authorized Representative) STATE OF INDIANA ) Robert A. Lingenfelter, President SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Robert A. Lingenfelter and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name an (fixed m official seal on the 27th day of June 2n�t 23 - r � �v otary Public Signah My Commission Expires; August 5, 2023 Rosidingin St. Joseph CountyIndiana ffaoaw�tVIEC St *k'TA i�y rumic. ate of indiano ti st Joseph County srA� . Commission M 671289 �•' My Commission Expires ��'......i+ August 05, 2023 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 07/6/2023 Name Kvle Ludlow Department Public Works BPW Date 07/25/2023 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 Gibson -Lewis, LLC New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Information U Yes U If Yes, Approved by Purchasing ® No MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Muessel Grove Park Restrooms 118-099R2 VPA Capital PO# 0019070-1 Acct. No# 416.0404.453.36.01 $416,803.00 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