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Home My WebLink AboutPCA - MPAC Carpet Replacement Proj No. 121-029B - Carpet Service Outlet1316 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 August 22, 2023 Ms. Vicki Shepard Carpet Service Outlet, Inc. 1514 Mishawaka Ave. South Bend, IN 46615 cgMetservice04kyahoo.com RE: Project Completion Affidavit — Morris Performing Arts Center Carpet Replacement Project No. 121-029B Dear Ms. Shepard: At its August 22, 2023 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $216,774.50. 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 ALEXANDRA DOLZ-LANE MURRAY L. MILLER AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of ViCKI SHEPARD (Name of Officer) ST. jOSEPH of CARPET SERVICE OUTLET INC (Subcontractor/Supplier) to furnish certain materials and/or labor as follows: being duly sworn that he/she is the SS: PRESIDENT (Title) having contracted with CITY OF SOUTH BEND CARPET AND INSTALLATION (Description) for a project known as MORRIS PERFORMING ARTS (Name of Project) located at 211 NO. MICHIGAN STREET SOUTH BEND INDIANA and owned by CITY OF SOUTH BEND 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 ❑ receipt of which is hereby acknowledged; or (Contractor) the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Caen which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL TEfNR) Icontractor is the sum ofINTM9_AN FDKY Me" ❑ 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 an account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other panty has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of (his Affidavit and Waiver of Lien. CARPET SERVICE OUTLET INC By(Fir (Author' d Representative) STATE OF INDIANA ) Y olandaGiles Notary Sealate of fn�iana SS; unty ST. JOSEPH COUNTY ) Commiap6s93i4Before me, the undersigned, a NO 1, Cs ip 15416 9 rr fate, personally appeared � L-L and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official sea o 1 day of 200 _AA Notary ublic Sn a e My Commission Expires: Residing in V County, �� - Ct No Public Name .�'4Ti_8f`k CITY OF SOUTH BEND, INDIANA �p BOARD OF PUBLIC WORKS " �� PROJECT COMPLETION AFFIDAVIT PROJECT NAME Morris Performing Arts Center Carpet Replacement PROJECT NO 121-029B FINAL COST $216,774.50 CONTRACT SIGNED 05/24/2022 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Remove and install new carnet in the Morris Performing Arts Center. 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. Exeout d this �. day of All 4 L 20'Q_�.�_. CARPET SERVICE OUTLET INC Company Name Signature 1514 MISHAWAKA AVE VICKI SHEPARD Company Address Printed Name WITNESSESS: B�fo e .me the unc C, �e the y of a Igna e Printed Name SOUTH BEND IN 46615 City, State, Zip igned Notary Public in and for said country and state, personally appeared _, and acknowledged his/her signature to the above Project Completion Affidavit'on 201 �-C-),\1 Yolanda 0 Giles Notary Public Seal State of Indiana SLJO&eph CQUnty C— mission Numbar NP06543U County of Residence If th-6 Contractor is a corporation, the following certificate will be executed_ I, VICKI SHEPARD certify that I am Secretary of the Corporation executing this release; that VICKI SHEPARD who signed this release on behalf of the contractor was then SECRETARY 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 o 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: Construction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS tatLa Elizabeth A. Maradik, President Gary A. Gilot, Member ma i Joseph R. Molnar, Vice President ut� aqA � Alexandra Dolz-Lane, Member Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: August 22, 2023 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/15/2023 Name Becca Plantz Department Public Works BPW Date 08/22/2023 Phone Extension 5998 Review and Approval Required Prior to Submittal to Board Diversity Compliance and Inclusion Officer ❑ Officer Name Cynthia Simmons BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Michael Schmidt 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 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 Purpose/Description Information Service Outlet, Inc. ❑ YesU If Yes, Approved by Purchasing ❑ No ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Morris Performing Arts Center Carpet Replacement 121-029B Morris Ca PO-16843 Lump Sum Closeout the project for carpet installation in the Morris Performing Arts Center. For Change Orders Onl 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: