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Home My WebLink AboutPCA - 2023 Curb & Sidewalk Program, Divisons A-E Proj No 123-001 - Premium Concrete Services - TABLEDPROJECT NAME PROJECT NO. CONTRACT SIGNED PROJECT DESCRIPTION CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PEACE PROJECT COMPLETION AFFIDAVIT x 1865 x 2023 Curb and Sidewalk 123-001 FINAL COST $956,974.57 08/22/2023 MAINTENANCE AGREEMENT ENDS Curb and sidewalk construction in South Bend (Divisions A, B, C, D, E) 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. E cu this d of Nov K- , 20 a � Premium Concrete Services, Inc. Si nature Company Name Becky Yeak y 712 Richmond Street Printed Name Company Address Elkhart, IN 46516 City/State/Zip WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally appeared 15cwJc.A w,4 Md acknowledged his/her signature to the above Project Completion Affidavit on the day of VET► , 20�_. No ry Signature My Commission Expires aOai(p - M706)kief Printed Name County of Residence ck� i a7 If the Contractor is a corporation, the following certificate will be executed. 1, _ Marc Ye aq , certify that I am Secretary of the Corporation executing this release; that &C 1w yf0-6i'l who signed this release on behalf of the contractor was then PrPcsi Cior�� of said Corporation; that said release was duly signed for and on behalf of said Corporation by A ority of its governing body, and is within the scope of corporate powers: Se/c�r�eta s Signature Corporate Seal 1 ' AV ye-ut Ll Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL 9 This project is acceptable for final approval and we recommend to the Board of Public Works that it e N ordained so. ¢ r z a Date: 12/23/2024 g; ConsAction Manager cr LLR�q CD J SOUTH BEND BOARD OF PUBLIC WORKS z W w CD oM ..� cwn z 2aco UJ }WW President Member fEz wa COz °- g zo �iLCQ az ozM Member Member � 65 0 _CS Member Attest J w FINAL WAIVER OF LIEN Becky Yeakey being duly sworn that he/she is the President (Name of Officer) (Title) of Premium Concrete Services, Inc. having contracted with City of South Bend (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: Curb and Sidewalk Construction for a project known as 123-001 2023 Curb & Sidewallc located at South Bend and owned by The Citv of South Bend (Description) (Name of Project) (Owner) 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 Three hundred twenty-three thousand, six hundred thirty-five and twenty-five cents (Amount Written Out) 323,635.25 ❑ 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. Premium Concrete Services, Inc. By (Firm) STATE OFJj�1Ql AtJ ) LZ COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared and acknowledged the execution of the foregoing Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the ksvcm bcK 20 .4 L� h day of My Commission Expires: oalj al aOo10 N tary Public Signature Residing in CLK I A RT, County JANEE M TOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 12/16/2024 Name: Gemma Stanton Department of Public Works — Engineering Division BPW Date: 1/14/2025 Phone Extension: 9083 Required Prior to Submittal to Board BPW Attorney X Attorney Name Michael Schmidt 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 ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ® PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution ❑ Other: ❑ Ease./Encroach Reauired Information Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Premium Concrete ❑ Title Sheet U Yes❑ If Yes, Approved by Purchasing ® No MBE ❑ WBE Completed E-Verify Form Attached ❑ Yes No 2023 Curb & Sidewalk 123-001 Motor Vehicle Highway / Major Moves 202-06-602-505-431000 / 412-06-600-506-431000 Division A - $55,159.10; Division B - $330,167.35; Division C — $243,834.34; Division D - $164,367.88; Division E - $163,445.90 Project closeout (PCA and waiver of lien) For Chan e Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount Current Percent of Change New Amount Increase % Decrease Increase % Total Percent of Change: Decrease Time Extension Amount: New Completion Date: