HomeMy WebLinkAboutUtility Extension Agreement Acceptance Proj No DP22-018 - Star Liquor1316 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
July 8, 2025
Mr. Pete Burns
S&J Real Estate Holdings LLC
140 Green Dr.
Avilla, IN 46710
pdburnskburnsdisttributing com
RE: Utility Extension Agreement Acceptance
Dear Mr. Burns:
At its July 8, 2025 meeting, the Board of Public Works approved the above referenced
acceptance.
Enclosed please find a copy for your records.
If you have any further questions, please call this office at (574) 235-9251.
Sincerely,
Is/Hillary Horvath
Hillary Horvath, 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
PROJECT NO.
CONTRACT
SIGNED
PROJECT
DESCRIPTION
Star Liquc
DP22-018
October 11, 2022
Utility Extension
FINAL COST $86,700.00
MAINTENANCE AGREEMENT ENDS N/A
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 ofthe above Contract.
Si aa�fi}
Printed Name
WITNESSES
20th day of June, 2025.
THOMAS PATRICK BURNS
Notary Public - Seal
Allen County - State of Indiana
Commission Number NP0664834
My Commission Expires Mar 2, 2031
Burns Distributing Co., Inc.
Company Name
140 Green Dr
Company Address
Avilla, IN 46710
City/State/Zip
Before me, the undersi for said country and state, personally
appeared Cory tx-o, , - ,,y,. , and acknowledged his/her signature to the above Project Completion
Affidavit on the fir, day of Jam,, �, , 20 aS
Notary Si afore My Commission Expires
2 v�'v, � til
1 U 3 I
��
Printed Name County of Residence e v�
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
Corporate Seal
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for final approval and we recommend to the Board of Public Works that it be
ordained so.
&A CITY OF BOARD O SOUTH
PUBLIC C WORKS
Cons tion Manager tu�a 1�ozm
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Joseph R. Molnar, Vice President
BreanaMjicou�,,/Member
`�C U f aA✓X&L,
Murray L. Miller, Member
Attest: Hillary R. Horvath, Clerk
Date: July 8. 2025
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
r t
1865
Member Attest
BURNS DISTRIBUTING CO.,INC.
140 Green Dr. • Avilla, Indiana 46710 • Telephone (260)897-2340 • Fax: (260)897-2246
UNCONDITIONAL WAIVER AND RELEASE
The undersigned has been paid for labor, services, equipment and material furnished to Star
Liquors off -site work located at 2240 Prairie Ave, South Bend, IN 46614
and does hereby release any mechanic's lien, stop notice or bond right that the undersigned
has on the above referenced job.
Dated: June 20th,2025
Contractor: Burns Distributing Co., Inc.
By
Name: Thomas Burns
�\ I GROUP
® NCB
surely
MAINTENANCE BOND
BOND NO, 0848020
KNOW ALL MEN BY THESE PRESENTS; THAT WE, S&J Real Estate Holding LLC
Harco National Insurance Company North Carolina Corporation
702 Oberlin Rd„ Raleigh, NC 27605
k„--•,u r,f ■ V O
as Principal, and
licensed to do business in the State of Indiana and , as Surety, are held and nrmiy Douno unto
City of South Bend
as Obligee, in the full And Just sum of Eight Thousand, Six Hundred Seventy and 001100 Dollars
( $ 8,670.00
Dollars lawful money of the United States of America to the payment of which sum, well and truly to be made,
the Principal and the Surety bind themselves, their successors and assigns, jointly and severally, firmly by these
presents,
SIGNED, SEALED AND DATED THIS 13th day of December 20 23
THE CONDITION OF THIS OBLIGATION IS THAT, WHEREAS the Principal entered into a contract with the
Obligee for Prairie Ave • Off Site Sewer[Water
AND WHEREAS, the Obligee requires a guarantee from the Principal against defective workmanship in
connection with said Contract.
NOW, THEREFORE, If the Principal shall make any repairs or replacements which may become necessary during
the period of 1211312023 thru 12/13/2026 because of defective workmanship in connection with said
contract of which defectiveness the Obligee shall give the Principal and Surety written notice within (30)
thirty days after discovery thereof, then this obligation shall be void; otherwise it shall be In full force and effect.
All suits at law or proceedings in equity to recover on this bond must be instituted within twelve (12) months after the
expiration of the maintenance period provided for herein,
Witness
Witness /!/� _
Allissa Nines, AdMin
1-83
S&J Real Estate Holding LLC
Kuljit Singh, Member
Hale+SNatipKal 1r)eurance Company
Attorney -in -Fact
POWER OF ATTORNEY Bond # 0848020
HARCO NATIONAL INSURANCE COMPANY
INTERNATIONAL FIDELITY INSURANCE COMPANY
Member companies of IAT Insurance Group, Headquartered: 702 Oberlin Road, Raleigh, North Carolina 27606
KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of
the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New
Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and
appoint
MICHAEL D. WILLAMS, JEREMY CRAWFORD
Golden Valley, MN
their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
Indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract
or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL
INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had
been duly executed and acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY
and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of
Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of
Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018.
"RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the
Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited
in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings,
recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation
may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute
waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed
by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written
obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the
Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same
force and effect as though manually affixed."
IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL
FIDELITY INSURANCE COMPANY have each executed and attested these presents
on this 31st day of December, 2018
.iNS... .,
STATE OF NEW JERSEY STATE OF ILLINOIS ; 0 p9oR4 .
,p
p�40R41 �9� County of Essex County of Cook = z'' GEAR i
SEAL F O 1904
,:
1804 o :0d'.. ONO��.'aa
dyjERs Kenneth Chapman %aS'
Executive Vice President, Harco National Insurance Company
and International Fidelity Insurance Company
On this 31st day of December, 2018 , before me came the individual who executed the preceding instrument, to me personally known, and,
being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and
INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the
said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies.
`'++I I Ill, r,
IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark,
•`��,�V:..• A'.•�G "'�,
New Jersey the day and year first above written.
;'.'.... <- �
Shirelle A. Outley a Notary Public of New Jersey
My Commission Expires April 4, 2023
CERTIFICATION
I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify
that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set
forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the
whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect.
IN TESTIMONY WHEREOF, I have herdunto's.et my hand on this day, December 13, 2023
A02712
ear -
Irene Martins, Assistant Secretary
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: 6/30/2025
Name: Gemma Stanton Department of Public Works — Engineering Division
BPW Date: 7/8/2025 Phone Extension: 9246
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 ❑ Title Sheet
❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes
❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
® Other: Utility Extension ❑ Ease./Encroach
Information
Company or Vendor Name
S&J Real Estate Holdings LLC
❑ Yes❑ If Yes, Approved by Purchasing
New Vendor
❑ No
MB❑
MBE/WBE Contractor
❑ E Completed E-Verify Form Attached ❑ Nos
Project Name
2240 Prairie
Project Number
DP22-018
Funding Source
N/A
Account No.
PRAP04 N/A
Amount
N/A
Terms of Contract
N/A
Special Contract Provisions
N/A
Purpose/Description
Water Extension Acceptance for 2240 Prairie
For Change Orders Only
Amount of ❑
Increase $
❑
Decrease ($ )
Previous Amount
$
Increase %
Current Percent of Change:
Decrease ( %)
New Amount
$
Increase %
Total Percent of Change:
Decrease ( %)
Time Extension Amount:
New Completion Date: