The URL can be used to link to this page

Home My WebLink AboutPCA - Dubail Street Sidewalk Proj No. 124-009B - Ortiz Construction1316 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 11, 2024 Ms. Erikka Martinez Ortiz Construction Inc. 1525 Magnolia St. South Bend, IN 46613 ortizconstructioninc2 (apyahoo. com RE: Project Completion Affidavit — Dubail Street Sidewalk — Project No. 124-009B Dear Ms. Martinez: At its June 11, 2024 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $13,676. 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 MURRAY L. MILLER BRIANA N. MIcou n o _ CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS =, PROJECT COMPLETION AFFIDAVIT PROJECT NAME Dubail Street Sidewalk PROJECT NO 124-009B FINAL COST S 13,676.00 CONTRACT SIGNED 4/9/2024 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Constrict sidewalk on Dubail St. between Philippa and Olive WITNESSETH: he 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. i;x,etrted this 5' day of -Ju.r1C 202-` Signature �rikko. M0.Yi1-V1CZ Printed Name Ortiz Construction Company Name 1525 Magnolia St Company Address South Bend, IN 46613 City, State, Zip WITNESSESS: More me, the undersigned Notary Public in and for said country and state, personally appeared 1V*9k 90►rr+YIZi and acknowledged his/her signature to the above Project Completion Affidavit on the 3 rcl day of v .20214 lsiutary Signature My Commission Expires �O [� rr1 G I S�ylvt C...ti Printed Name County of Residence', If the Contractor 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 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: 6/4/2024 Co traction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS VILa Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member M Joseph R. Molnar, Vice President Briana Micou, Member Attest: Theresa M. Heffner, Clerk Date: June 11, 2024 vn to N w Q c� ¢ in �Uca 0 H_Jft�ZZ0S Z05 05Cr w z —M aaQ2 w ou3�F- �z0Ow < 4 Q�Q x r LLI 0 Final Waiver of Lien State ofIndiana, County of MRA gq� §WM Mat h@/§k i§ #Ie &rs Wzvi 4- - (Name of"Officer) (Title) Of Z on L�S'1 uv) nc C o� tau h_ &nd (Contractor) (Owner) to furnish certain materials and/or labor as follows: Lrl tYtfit s ; clev •rc.\ 1<S CUr b_ 4 b/+ 2c�m� _ i oiq I Iti I i ri - (Description) for a project known as located at and owned by D0-1& (Name ofProject) ..CVOgi1 �Arccy sidcsv0.�S - - (fie') and does hereby further state on the behalfofthe aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due firm the Contractor the sum of ® receipt ofwhich is hereby acknowledged; or 01 the payment ofwhich has been promised as the sole consideration for this Affidavit and Final Waiver ofLienwhich is given solely with respeeato said amount, and which waiver shall be effective only upon receipt offpayment thereof by the undersigned; (FINAL WAIVER) that the final balance due#om the contractor. is the sum of +hir3ccv� is Skylr� ��x i��icy l' r S�•l'+'i'i'�SIY+ �� _ t4--]( ttk _. Q] receipt of'which is hereby acknowledged; or �J the payment ofwhich has been promised as the sole consideration for this Affidavit and Final Waiver ofLien which shall become effective only upon receipt ofsuch 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 an account oflWnfi- or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other patty 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 ofthis Affidavit and Waiver of9,ieu. (Firm) (Autho ' eprasentative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) �-ILe�G(�h Ylt? Z Bef n me, the undersigned, a Notary Public, In and for said County and Stale, personally appeared _-- — — — — — — — — and acknowledged the execution ofthe foregoing Affidavit and Waiver ofLien. IN Wss WHEREOF, I have hereunto subscribed my n r a and affixed my official 1 on the oa dwof tY �", Notary Public Signature My Conunission Exphw: 2• Residing in Jb t`,\ ` County, `1(L Otiy-L 4 M(A' i S YA a v Notary Public Name r PU. MARIA RUSTMAN r° 'o NOTARY PUBLIC * SE& * COMMISSSON NO. MP0736M eg MY COMMISSION EXPmLS OFSµp�p SEPTEMBEFI a. 2029 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 6/3/2024 Name: Gemma Stanton Department of Public Works — Engineering Division BPW Date: 6/11/2024 Phone Extension: 9083 Required Prior to Submittal to Board BPW Attorney 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 n Other: n Ease./Encroach uired Information Company or Vendor Name Ortiz Construction ❑ Yes ❑ If Yes, Approved by Purchasing New Vendor ® No MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached ❑ No Project Name Dubail Street Sidewalk Project Number 124-009B Funding Source PO-0030605 Account No. 202-06-602-505-431000-PROJ00000514 Amount $13,676 Terms of Contract Lump Sum Purpose/Description PCA and Waiver of Lien for Dubail Street sidewalk construction with Amount of ❑ Previous Amount Current Percent of Change New Amount Total Percent of Change: Time Extension Amount: New Completion Date: Ortiz Construction for $13,676 Increase $ Decrease ($ ) Increase % Decrease Increase % Decrease