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Contractor's / Subcontractor's <br />THIECAN <br />Change Order Request Summary <br />$ .._ <br />Date: 9/19/2016 COR: 7 <br />A, Merrillville, IN 46410, 219-947-4700 phone/ 219-947-4711 fax <br />General Contractor <br />521 W. 84th Drive Suite <br />Engineer: Greeley and Hansen Owner: City of South Bend <br />Project: South Bend Grit and Screenings <br />Improvements <br />TCI Job # 1511 <br />and install five (5) analog feedback cards to the existing rotork actuators. Proposal includes installation and <br />SUMMARY OF DETAILED BREAKDOWN <br />Additions <br />Deletions Net Total <br />LABOR <br />$ $ <br />$ <br />MATERIAL <br />$ - $ <br />$ <br />EQUIPMENT <br />$ - <br />$ <br />OTHER COSTS <br />1. SAFETY <br />(1%of LABOR)- Deletion -0- <br />$ - <br />2. EXPENDABLE TOOLS <br />(3.0%of LABOR-Deletion-0- <br />NET TOTAL <br />(A+B+C+Dl+D2) <br />$ - <br />OVERHEAD AND PROFIT <br />(Ex15%) - Deletion -0- <br />$ - <br />TOTAL WORKPERFORMED BY CONTRACTOR <br />(Lines E+F) <br />$ - <br />CONTRACTOR'S MARK-UP ON WORK OF SUBCONTRACTORS <br />Detailed Breakdowns and summaries from each contractor must be attached. <br />SUBCONTRACTOR: Firm Name <br />1. Toric Engineering <br />2. <br />3. <br />4. <br />CONTRACT WORK: Description PROPOSAL <br />Add 5 Analog Cards $7,175.00 <br />SUBTOTAL of all work performed by contractor's subcontractors $7,175.00 <br />MARK-UP on work of subcontractors (Min. $ .00) (Line H x 5%)- Deletion -0- $358.75 <br />PROPOSAL (Lines G+H+I) $7,533.75 <br />BONDS (1.5"%of PROPOSAL-Deletion-0- $113.01 <br />BUILDER'S. RISK INSURANCE (0.0% of PROPOASL) - Deletion -0- <br />$7,646.76 <br />TOTALPROPOSAL <br />TOTAL PROPOSALfor subject COR increase (decrease) in contract amount $7,646.76 <br />An extension time of 50 days to extend the Contract dates for Completion will be required commencing on <br />the date when we are notified a Change Order will be issued for the price quoted herein. Approval needed in 5 days. <br />If the work has to be performed to continue construction with no response on pricing or if we are issued a Work <br />Change Directive (WCD) to proceed with this work and agreement on the price has not been reached within 30 <br />calendar days, then this proposal shall be considered a Claim, in accordance with Article 10.5 of the <br />Contract General Conditions. <br />CONTRACTOR <br />Signature .Mnft.McPary Title: PM Date: 9/19/2016 <br />