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Home My WebLink AboutPCA - 2022 Curb & Sidewalk, Round I - Division 3-5 Proj No. 122-001 - Premium Concrete1316 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 November 14, 2023 Mr. Max A. Yeakey Premium Concrete Services, Inc. 712 Richmond St. Elkhart, IN 46516 rbeckergpremiumconcreteonline. com RE: Project Completion Affidavit — 2022 Curb and Sidewalk, Round I - Divisions 3-5 Project No. 122-001 Dear Mr. Yeakey: At its November 14, 2023 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $403,537.98. 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 ALEXANDRA DOLZ-LANE MURRAY L. MILLER Q_0UTf) @4 CITY OF SOUTH BEND, INDIANA r BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Iu5 PROJECT NAME Curb and Sidewalk PROJECT NO 122- 001 FINAI COST. 403 537 98 CONTRACT SIGNED 719619099 MAINTENANCEMAIWIENANCE AGREEMENT ENDS PROJECT DESCRIPTION Qjrh and Sidewalk replacement at various locations 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 ofthe above Contract. JExecuted this 5q ay of— unL , 2aJ _Premium Concrete Services, Inc. Company Name Signature 40r 712 Richmond St. Xp&keu Company Address Printed Name Elkhart, IN 46516 City, State, Zip WITNESSESS: Before rnie, the undersigned Notary Public in and fo MNK ItA KEN and acknowledged his/her the_ -day of l Ili 20,D_�,_. No ary Signature Printed Name r said country and state, personally appeared signature to the above Project Completion Affidavit on My Commission Expires County of Residence If th�,Contractor is a corporation, the following certificate will be executed. Ick- V Y. certify that I am Secretary of the Corporation executing this release; that 'iuy , who signed this release on behalf of the contractor was then VI �•.�r r1r1r10rA - of said Corporation; that said release was duly signed for and on behalf of said R0rp`ora`)on byAAuthoriyJof it§ govelning body, and is within the scope of corporate powers: Printed DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal 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 -lea Elizabeth A. Maradik, President Gary A. Gilot, Member 774, 4 Murray L. Miller, Member Joseph R. Molnar, Vice President Alexandra Dolz-Lane, Member yrk�� Attest: Theresa M. Heffner, Clerk Date: November 14, 2023 JANEE MTOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 202 COMMISSION NO.710399 Final Waiver of Lien JANEE M TOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO, 710399 State oflndiana, County of SS: M Qu y g,a,, being duly sworn iha he he is the V t LQ — Pyew eni (Neale ofOffiear) (Title) of &tlYNa_M lonQJ riiu5 Ines having contracted with D� Sotd'II germ (Contractor) (Owner) to flunish certain materialsand/or labor as follows; £or a project known as and S,, ieeatedat various to ofrons and owned by A-hl d (Di h !Rend and does hereby further state on the behalf ofthe atom•ementiouedsubcontractor/supp4er: (PARTIAL WAIVER) that there is due iiom the Contractor the sum of Dollars ($ ) ❑ receipt of which Is hereby actntowlodged; 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 effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due Earn the contractor is the sum oP 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 became offeOuVe only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner ofsaid premises, any and all liens or claims whatsoever on fire above-dasoibedproperty and improvements thereon an account of tabor ormaterial or boW, furnished b the rmdexsigued thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party 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 this Affidavit and Waiver of Lien, bemlum e ry tk.Soryiu ; (nc ay (Firm) (Authorized Representative) STATE OF INDIANA ) �fkrlflrr ) Ss: -8=0911R I COUNTY ) Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared t rr 1 %� l� r k K(= and nolaiowledged the execution of the foregoing Affidavit and Waiver of Lien. ��-� IN WITNESS WHEREOF, I Lave hereunto subscribed my name and affixed my official seal on the l _ day of :] i_i ISE 2ae dL3 G t �o✓ � J ly Notary public signature My Commission Expires: O4 (3� I ��i L(4 JAQ CC TC� IJ CPS Residingin tt6 IAK�T County, TNDI AQk Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/2/2023 Name Kvle Ludlow Department Public Works BPW Date 11/14/2023 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 Premium Concrete Services Inc. ❑ Yes ❑ If Yes, Approved by Purchasing ® No MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos 2022 Curb and Sidewalk Round 1 122-001 MVH PO# 0018633-1 Acct. No# 101-04-040-040-439001 $403,537.98 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