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Home My WebLink AboutPCA - 2024 Contracted Microsurfacing Proj No 124-049 - Asphalt Restoration Services1316 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 December 10, 2024 Mr. Sean Evans Asphalt Restoration Services PO BOX 2484 South Bend, IN 46680 Andrea.brown2gcomcast.net; arsllc&comcast.net RE: Project Completion Affidavit — 2024 Contracted Microsurfacing — Project No. 124-049 Dear Mr. Evans: At its December 10, 2024 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $106,804.65. 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/hh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BREANA N. MIcou CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS] PROJECT COMPLETION AFFIDAVIT' PROJECT NAME Micro -Surfacing PROJECT NO 124-049 FINAL COST $106.804.65 CONTRACT SIGNED 7/23/2024 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Micro -Surfacing: Edison, Scenic, Mayfair and additional spots throughout City WITNESSETH: fhe 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. Lxecuted this s� day of_Qet�o%v 202_' Asphalt Restoration Services Company Name tr ure PO Box 2484 Company Address Printed Name WITNESSESS: 202. Notary Sfgnature My Commission Expires t Printed Na:ne County of Residence If the Contractor is a corporation, the following certificate will be executed. South Bend. IN 46680 City, State, Zip �,, DANA TROWBRIDGE 1?.••••,9�%; Notary Public, State of Indian ° St. Joseph County ==:SEALi"" o c Cmmission Number NP071788 ••••N My Commission Expires January 02, 2027 lit 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 Na_rtte 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. u ,L_60&6V_ Date: 11 /26/2024 Co truction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS G� Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R`.-Mo�lnaarr, Vice President Briana Micou, Member Ot Attest: Theresa M. Heffner, Clerk Date: December 10, 2024 FINAL WAIVER OF LIEN being duly sworn that he/she is the _ �_-.---- (Name of Officer) (Title) of 5t) ,k iCP Q_5erV1tr5having contracted with (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows 5 u rr (�fP (il rGkt°5 t :Crlptjon) for a project known as V[ `1— (Name of located at and owned by and does hereby further state on the behalf of the aforementioned subcontractor/supplier: FINAL WAIVER that the final balance due from the contractor is the sum of (Amount Written Out) ❑ 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 furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. �%u1T 1\eS��G�;on �y�Gp-S (Firm) Date _.Z ! 4-_7- By STATE OF iQ ) ) SS: Be Core me, the undersigned, a Notary Public, in and for said County and State, personally appeared Scan--l.wGK,(-)S and acknowledged the execution of the foregoing Waiver of Lien. 1 WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on theday of 20 My Commission Expires: �� aoa 2 Notary Pubh Signature Residing in F County Notary Pub 'c Name �P,.•.,,g�'; Notary Public, State of Indiana o' Elkhart County z SEAC; * ,Commission Number NP0713941 My Commission Expires May 30, 2121 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/26/2024 Name Kvle Ludlow Department Public Works BPW Date 12/10/2024 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 Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Information Restoration Services U Yes U If Yes, Approved by Purchasing ® No E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Micro -Surfacing 124-049 251-431000 PR-00033529 PO-0032976 $1 Purpose/Description _Project Closeout For Change Orders Only Amount of Increase $ Previous Amount ❑ Decrease Current Percent of Change New Amount Increase Decrease Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: