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Home My WebLink AboutPCA - 2020 Traffic Signal Detection Improvements Proj No. 120-046 - JBL Signals & Lighting 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 March 12, 2024 Mr. Tanner Leibovitz JBL Signals and Lighting LLC 4316 Technology Dr. South Bend, IN 46628 tannerlgjblsignalsandlighting com RE: Project Completion Affidavit — 2020 Traffic Signal Detection Improvements Project No. 120-046 Dear Mr. Leibovitz: At its March 12, 2024 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $113,668.80. 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 MURRAY L. MILLER BRIANA N. MIcou CITY OF SOUTH BEND, INDIANA F 1 BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT'°'; PROJECT NAME Traffic Signal Detection Improvements PROJECT NO 120-046 FINAL COST $113,668.80 CONTRACT SIGNED 12/14/2021 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Upgrading of intersections traffic detection equipment at various areas throughout the City. 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. Executed day of F, 202JBL Signals and Lighting LLC Company Name Sature 4316 Technology Dr. i1Q h �� L �0 Company Address Printed Name V South Bend, IN 46628 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared r,j,n )n([-IP- L & I Sv t ) l,Tan-f acknowledged his/her signature to the above Project Completion Affidavit on th t7 day of F k U q02 Y Q/� Rotary -Signature My Commission Expires Printed Name County of Residence tf the Qontractor is a corporation, the following certificate will be executed. Debra A Urbanski Notary Public Seal State of Indiana St. Joseph County Coam My Commission Expires 03/09/2029 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 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: 2/26/2024 Col traction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS �ffl Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Vice President Briana Micou, Member Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: March 12, 2024 Final Waiver of Lien State of Indiana, County of �� SS: Tonn �i- LeA boyi It- being duly sworn that he/she is the {•�j)Q,Q�� (Name of Officer) (Title) of 1 IS 0,nd�' having contracted with City of South Bend ( ontractor) J (Owner) to furnish certain materials and/or labor as follows: (Description) for a project known as (Name of Project) located at and owned by City of South Bend (Owner) 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 acIozowledged; 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 from 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 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 party has any claim or right to a lien on account of any work performed or material famished to the undersigned for said project and within the scope of this Affidavit and Waiver of Lien. I I By (Firm) (Authorized Representative) STATE OF INDIANA ) SS: ST, JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared and aclaiowledged the execution of the foregoing Affidavit and Waiver of Lien. v IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official sea] on the t day of 202'� Notary Public Signature Debra A Urbansro My Commission Expires: Notary Public 1\ 1 t t.JosephCounhs ission # NP0732273Notary Public Name Residing inLZ4ssion E BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 02/26/2024 Name Kvle Ludlow Department Public Works BPW Date 03/12/2024 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 Information Company or Vendor Name JBL Signals and Lighting LLC New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract U Yes U If Yes, Approved by Purchasing ® No E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Traffic Signal Detection Improvements 120-046 2020 Signal Funding PR-00011593 PO-0013627 $113 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