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Home My WebLink AboutPCA - South Bend CIty Hall Renovations Proj No0124-001 - Larson-Danielson April 14, 2026 Mr. Brian T. Larson Larson-Danielson Construction Co., Inc. 302 Tyler Street LaPorte, IN 46350 abl@ldconstruction.com; smo@ldconstruction.com RE: Project Completion Affidavit – South Bend City Hall Renovation – Project No. 124- 001 Dear Mr. Larson: At its April 14, 2026 meeting, the Board of Public Works approved the Project Completion Affidavit for this project in the amount of $7,921,618.86. A copy of the Project Completion Affidavit is enclosed for your records. Sincerely, /s/ Hillary Horvath Hillary Horvath, Clerk CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT ____________________ FINAL COST____________________________________ PROJECT NAME PROJECT NO PROJEC DESCRIPTION__________________________________________________________________ _ 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. Executed this ________ day of _________________, 20______. _____________________________ Company Name __________________________________________ Signature _____________________________ Company Address __________________________________________ Printed Name _____________________________ City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared ______________________________, and acknowledged his/her signature to the above Project Completion Affidavit on the ______ day of ______________, 20_________. __________________________________________ ________/_________/20_________ Notary Signature Commission Expiration __________________________________________ _____________________________ Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. I, ___________________________, 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: __________________________________________ ____________________________________ __________________________________________ Printed Name Corporate Seal ______________________________________________________________________ 12 -0 South Bend City Hall Renovation Renovate the former South Bend Community School Corporation into City Hall. 9th April 26 Larson-Danielson Construction Co., Inc. 302 Tyler Street La Porte, IN 46350 David J. Merkel David J. Merkel 9th April 26 Jennifer A. Waltz 08 01 30 La Porte Jeffrey R. Jensen Jeffrey R. Jensen Vice President David J. Merkel NOTARY SEAL JENNIFER A. WALTZNotary Public, State of IndianaLa Porte CountyCommission # NP0654434My Commission Expires August 1, 2030 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. ____________________________________________________ Date:___________________________ Construction Manager SOUTH BEND BOARD OF PUBLIC WORKS President Member Member Attest 04/07/2026 April 14, 2026 FINAL WAIVER OF LIEN being duly sworn that he/she is the (Name of Officer) (Title) of having contracted with City of South Bend (Contractor) (Owner) to furnish certain materials and/or labor as follows: (Description) for a project known as (Name of Project) located at and owned by City of South Bend (Owner) and does hereby further state on the behalf of the aforementioned contractor: 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. Date By (Firm) (Authorized Representative) STATE OF __________ ) ) SS: ___________ 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 day of 20 . My Commission Expires: Notary Public Signature Residing in County Notary Public Name South Bend City Hall Renovation 215 S Dr. Martin Luther King Jr. Boulevard South Bend, IN 46601 X Jeffrey R. Jensen Secretary / Treasurer Larson-Danielson Construction Co., Inc. Two Hundred Thirteen Thousand Nine Hundred Thirteen and 71/100 Dollars 213,913.71 Larson-Danielson Construction Co., Inc. April 9, 2026 Indiana La Porte Jeffrey R. Jensen 9th April 26 August 1, 230 La Porte Jennifer A. Waltz UBLP ICYRATON FIND IA NAOETA TSNOTARY SEAL JENNIFER A. WALTZNotary Public, State of IndianaLa Porte CountyCommission # NP0654434My Commission ExpiresAugust 1, 2030 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 4/7/2026 Name: Becca Plantz Department of Public Works – Engineering Division BPW Date: 4/14/2026 Phone Extension: 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: Ease./Encroach Required Information Company or Vendor Name Larson Danielson Construction Company New Vendor Yes If Yes, Approved by Purchasing No MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached Yes No Project Name South Bend City Hall Renovation Project Number 124-001 Funding Source Economic Development LIT, TIF, Water & Sewer Capital Account No. PROJ 362 Amount Terms of Contract Purpose/Description Recognizing project completion of the South Bend City Hall Renovation. For Change Orders Only Amount of Increase Decrease $ ($ ) Previous Amount $ Current Percent of Change: Increase Decrease % ( %) New Amount $ Total Percent of Change: Increase Decrease % ( %) Time Extension Amount: New Completion Date: