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Home My WebLink AboutPCA - VPA Splashpad Renovations Proj No 123-044 - Premium 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 JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS June 24, 2025 Mr. Max Yeakey Premium Services, Inc. 712 Richmond St. Elkhart, IN 46516 becky(a),premiumservices. group; RE: Project Completion Affidavit — VPA Splashpad Renovations — Project No. 123-044 Dear Mr. Yeakey: At its June 24, 2025 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $497,809.38. 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/Hillary Horvath Hillary Horvath, Acting Clerk Enclosures 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 VPA Splashpad Renovations PROJECT NO 123-044 FINAL COST $497,809.38 CONTRACT SIGNED 9/26/2023 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Removol and Replacement of South East Park and CoQuillard Park splash pads WIT'NESSETH: 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 this 13 day of rCrb!'it6lrer 202 Premium Services Company Name Signatur 712 Richmond St &y &dJ4q Company Address Printed Name Elkhart, IN 46516 City, State, Zip ore me, he undersigned Notary Public in and for said country and state, personally appeared p17( zV and acknowledged his/her signature to the above Project Completion Affidavit on he 15"4-' day of FrBizu WA, 202 . ry Signature My Commission Expires V owl91W Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed, I, (3�y L VcW4.ir certify that I am Secretary of the Corporation executing this release; that CfCWkA4 who signed this release on behalf of the contractor was then r — vcf i of said Corporation; that said release was duly signed for and on behalf of said Col ion by uthor' of t go ping body, and is within the scope of corporate powers; S tary's Sig tur Corporate Seal w u Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to (lie Board of Public Works that it be ordained so. XlaA .L-44a!�e,6.4V. Date: 6/4/2025 Cor ruction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Vice President Briana Micou, Member f Arm / ac-hn� Murray L. Miller, Member Attest: Hillary Horvath, Acting Clerk Date: 6/24/25 State af7ndiana, Gounty of ��%�� SS: X�`_ �� bahtg duly sworn that he/she !s tho ail (� — Qi2�i �(.2f1,�' {Name of ftloer) (Title) f :�� :,� for a project known as having contracted with G p � , (Owner) and does hea�eby flusher state on the behalf ofthe aforemendoued subcontractorJsuppller; (PARTIAL WAIVBR) that ther8 is due from Hio Contractor the sum of Dollars ,�($ ) _� ❑ receipt of which is hereby acin►owledged; or ❑ the payment of which has been promised as the sole consideration fox this Af�dsvlt and Final Waiver of Llenwhlch is given solely with respect to said amount, and which waiver shall be effective only upon receipt ofpaymentthereof bythe undersigned; �: � .� � �. L V► ..�.�- .-� ,,� .�.� .•� �► �� . � r ❑ receipt ofwhich is hereby eolmowledged; or the payment of which has been promised as iha sole consideration for this Atliidavlt and Fiaa! Waiver of Lien whioh shalt beoome offeotiva on;4y uponreceipt of suoh payment. THBitRFORB, the undersigned waives and releases unto the Owner of said premises, any and al! liens or claims whatsoever on the above -described property and improvements thereon au account of labor or material or both, t%rnished b the unders[gned thereto, subject to limitations or conditions expressed hereia, if any; and further certified ihatno other party has any claim or right to a lien on eccount of any work performed or material iitrnishad to the undersigned for said project, and within the scope ofthis Affidavit and Walvcrofiiem. '�� :, „� .: . ~ _ 1 a, � r,, , t ., .� M , SEAL ELKHART COUNTY, STATE OF INDiANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO.710399 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 06/04/2025 Name Kvle Ludlow Department Public Works BPW Date 06/24/2025 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 Services. Inc U Yes U If Yes, Approved by Purchasing ® No MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos VPA Splashpad Renovations 123-044 PR-00026702 PO-0026735 $497,809.38 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: