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HomeMy WebLinkAboutChange Order No. 1 (Final) 2016 Tree & Stump Removal Project No. 116-016 KC Tree, Inc.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND_ INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS October 25, 2016 Ms. Diane Szulczyk KC Tree, Inc. 1320 Third Street Osceola, IN 46561 PHONE 574/235-9251 FAX 574/235-9171 RE: Change Order No. 1 - 2016 Tree & Stump Removal (Final)/Project Completion Affidavit Project No. 116-016 Dear Ms. Szulczyk: The Board of Public Works, at its meeting held on October 25, 2016, approved the Final Change Order for the above referenced project, for an increase of $3,125,00. The new Contract sum is $33,205.00. In addition, the Project Completion Affidavit for this project was approved in the amount of $33,205.00. Copies of the Change Order and Project Completion Affidavit are enclosed for your records. If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, Linda M. Martin, Clerk Enclosures GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU � CITY OF SOUTH BEND, INDIANA 9JviHLf46 DEPARTMENT OF PUBLIC WORKS y , PROJECT CHANGE ORDER DATE: 10/4/2016 0:00:00 PROJECT NO: 116-016 PROJECT NAME: 116-016 Zoi(, —Mee # STJHP 214+y4L. CONTRACT DATE: 4/19/2016 CHANGE ORDER NO: 1 SUBJECT OF CHANGE ORDER: PCR #1-Extra Trees PCR #2-Extra Trees The original contract sum $ 30,080.00 Net change by previously authorized change orders $ 0.00 The contract sum prior to this change order $ 30,080.00 By this Change Order, the project amount is �X Increased 71Decreased $ 3,125.00 The new contract sum including this change order This Change Order represents a total change of Total change for entire project Original contracted completion date/time 11/1/2016 0:00:00 Extension of date/time by previous change orders 0 days Date/time extension by this change order 0 days New completion date/time 11/1/2016 CONTRACTOR ni,n Contractor Sig ture Printed Name and Title KC Tree, Inc. Company Name 1320 Third St Address Osceola, IN 46561 City, State, Zip 33,205.00 10.39 % 10.39 % RECOMMENDED FOR APPROVAL --tea VQP. CONST TION MANAGER CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Approved Date: Jo a S-,) c.I (Co J. A. Mueller. Member PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Remove trees and 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 ( by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cit. of South Bend which were a part of the above Contract. Executed this 13 day of ©L- olaQx �r1�7/Ii _. KC Tree, Inc. j Company Name OTA,Q Signature `' 1320 Third St Lt,Lc vc CA,�.rryholmes Company Address Printed Name Osceola, IN 46561 AV9L�G City, State, Zip WITNESSES: �9JFnn\Q`� Before me, the undersigned Notary Public in and f and state, personally appeared xhn✓ , 'hwrvhdwc.cand acknowledged his/her signature to the above Project Completion Affidavit on theblytt` day pof d)AAu t_ , 201 C. ��t2 l h a,os.e , z11 Notary Signature My Commission Expires Eeibau my y S, cZo3.4 I)IANC- SzL tczy(c J Printed Name County of Residence S -r o5C.PH 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: Secretary's Signature Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable or nal approval and we recommend to the Board of Public Works that it be ordained so. • Date: t O • t Pi • I (r Constructerr anager . P i City of South Bend Project No. 116-016 Change Order No. 1 - 10118116 OWNER: City of South Bend ENGINEER: City of South Bend Engineering Patrick C. Kerr, PhD., P.E. Professional Engineer No. 10707546 CONTRACTOR: KC Tree Service PROJECT: 2016 Tree & Stump Removal Project No. 116-016 SUBJECT: Clarifications and Revisions to Contract Documents ISSUE DATE: May 14, 2016 This Change Order to the Contract document shall supplement, amend, and shall become a part of, and be incorporated as an Addendum to the Contract. The following is a summary and description of the revisions to the Contract by this Change Order: 1. Tree & Stump removal extra quantity. The following sections of the Contract Documents are revised as a result of the above changes: XVIII. Tree & Stump Removal B. Additions.: "Additional three (3) tree removals. BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 10/18/16 Name Toy Villa Department Engineering BPW Date 10/25/16 Phone Extension 5920 Required Prior to Submittal to Board Legal ❑ Attorney Name Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ I Check the Appropriate Item Type — Required for All Submissions ❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Change Order No. ® C/O & PCA No. 1 Final ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control ❑ Other: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description KC Tree Service ❑ Yes ® No ❑ If Yes Approved by Purchasing I -I MBE I -I WBE Yes Name of & Stump Rem 202.0607.431.36.01 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. Required For Change Orders Only Amount of ® Increase $ 3,125.00 ❑ Decrease $ Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ ® ❑ 30,080.00 0.39% 10.39 10.39% Dispersal After Approval Terri Swift is Correa