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Home My WebLink AboutChange Order No. 2 - PCA - Jefferson Boulevard Striping Phase I Proj No 116-037A - Airmarking Co1316 COuNTY-CITY BUILDING 227 W. JEFFERSON BOuLEVARD SOUTH BEND_ INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS December 13, 2016 Greg Lowe Airmarking Co., Inc. PO Box 526 Rochester, IN 46975 RE: Change Order No. 2 (Final)/Project Completion Affidavit - Jefferson Boulevard Striping, Phase I - Project No. 116-037A Dear Mr. Lowe: PHONE 574/235-9251 FAX 574/235-9171 The Board of Public Works, at its meeting held on December 13, 2016, approved the Final Change Order for this project, for a decrease of $346.00. The new Contract sum is $56,738.00. In addition, the Project Completion Affidavit for this project was approved in the amount of $56,738.00. 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, L Linda M. Martin, Clerk Enclosures c:Toy Villa, Engineering Cecil Eastman, Finance GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMEs A. MUELLER THERESE J. DORAU SOIL IH b CITY OF SOUTH BEND, INDIANA 4 DEPARTMENT OF PUBLIC WORKS �,�.f PROJECT CHANGE ORDER ess DATE: 10/20/2016 PROJECT NO: 116-037A PROJECT NAME: Jefferson Boulevard Striping Phase I CONTRACT DATE: 9/13/2016 CHANGE ORDER NO: 2 (Final) SUBJECT OF CHANGE ORDER: _PCR #2-Final Quantity Adjustment All items completed substantially as planned. See attached Comparison of Estimate for overruns and underruns. The original contract sum $ 57,084.00 Net change by previously authorized change orders $ 0.00 The contract sum prior to this change order $ 57,084.00 By this Change Order, the project amount is Increased XQ Decreased $ 346.00 The new contract sum including this change order $ 56,738.00 This Change Order represents a total change of -0.61 %H Total change for entire project -0.61 % Original contracted completion date/time 10/15/2016 Extension of date/time by previous change orders 3 days Date/time extension by this change order 0 days New completion date/time 10/18/2016 CONTRACTOR Contract 8fgfiature 64L u_ Printed Name and Title Airmarking Co., Inc. Company Name P.O. Box 526 Address Rochester, IN 46975 City, State, Zip RECOMMENDED FOR APPROVAL CONS CTION MANAGER CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Approved Date: J-�2 j'/�o(' xy `-1 G( r Gary A. Gilot, President Elizabeth AMaradik, Member v The rese J. D rau, Member Ja es A. Mueller, Member PROJECT NAME Je PROJECT NO 11 CONTRACT SIGNED 9/ PROJECT DESCRIPTION WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT FINAL Blvd between Eddy St. and a center turn lane 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. this ' daygf W Q\rE MISER 201 (o Name Airmarking Co. Inc. Company Name P.O. Box 526 Company Address Rochester, IN 46975 City, State, Zip WITNESSESS: B fore me, the undersigned Notary Public in and for said country and state, personally appeared �R� r� L OIJE , and acknowledged his/her signature to the above Project Completion Affidavit on the day of 0 Eft 201�. Notary Signatur My Commission Expires SEFEE H ESE 14AN L. Pi �E Printed Name County of Residence RLToK If t1A Contractor is a corpn, the following certificate will be executed. 1, L. oratiocertify that I am Secretary of the Corporation executing this release; that O L_�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 Auth ity of its overning body, and is within the scope of corporate powers: Q Secretary's Sign re , f Corporate Seal Printed Name t� DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable fo fin I approval and we recommend to the Board of Public Works that it be ordained so. ^, Date: l 1- Z- t c Constructior&nager v a BOARD O PUBLIC WORKS APPROVAL Date: /_2 /3 � ZE Gary A. Gilot, President zanna M. berg, Me er Elizabeth A. Maradik, Member Therese J. D ra vlember Ja I s A. Mueller, Member ':Ein' 'a M. Martin, Clerk —IF— AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of Fulton SS: Greg Love being duly sworn dtathelshe is the Preniflpn} (Name of Officer) (Title) of The Airmarking Go., ine. having contracted with The Airmarkin¢ co. Inc. (Subcontractor/Supplier) (Contractor) to furnish certain materials andloriabor as follows: memant Marking-n (Description) for a project known as Jefferson Boulevard Striping Phase 1 116-037A) (Name of Project) located at _ Jefferson Boulevard Smith Bud IN and owned by City of South Bend and does hereby further state on the behalf of the aforementioned subcontractar/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars _ (S' ) ❑ 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 is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the. uaddersigned; (FINAL WAIVER) that the final balance due from the contractor is. the sum of FTFKY Srx • HOMANn SEMM EIRMvn Tnrumv F"ECEE MLLARS _ ($56, 738.Oq ❑ receipt ofwhich 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'w.aives and releases unto the Owner of saidpreinises, anyand all liars or claims: whatsoever on the above.desctibed property bnprovemehts thereon an account of labor or material or both, furnished b the undersigned thereto; subject to limitations or conditions expressed herein, if any, and f nther certified that no other arty has any claim oX right to e lien on account of any work performed or material furnished to the undersigned fa s ' project, and yftthin:the scope ofthis Affidavit and Waiver ofLien. f, /J The Airmarkfng Co.,Inc. By� (F�) Greg a (uthorizedRepmsentative) STATE OF MIANA. ) SS: ST. dOSEPH COUNTY ) Before me, the undersigned; a Notary Public, imand for said County and State, personalty appeared Greg Lowe and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I,have hereunto subscribed mymand affixed my official seal on the r4sd Of November 200 l NotatyPublit S" Penny L. Pike My Commission Expires September 21.2022 Residing in Rochester, IN C Pe nnY L. Pike County, Fulton County Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11/17/16 Name Toy Villa Department Engineering BPW Date 12/13/16 Phone Extension 5920 Required Prior to Submittal to Board Legal ® Attorney Name Michael Schmidt 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 ❑ the Appropriate Item Tvoe — Agreement Professional Services Bid Opening Quote Opening Change Order No. Ease/Encroach. Other: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount ❑ Contract ❑ Resolution ❑ Bid Award ❑ Quote Award ® C/O & PCA No. 1 Final ❑ Traffic Control Required Information markin Co., Inc. Yes No ❑ If Yes MBE ❑ WBE No F Yes Name of Co !d for All Submissions ❑ Proposal ❑ Req. to Advertise ❑ PCA Approved by Purchasi mpany Phase I ❑ Title Sheet Terms of Contract Purpose/Description 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 $ ® Decrease $ 346.00 Previous Amount Current Percent of Change New Amount Total Percent of Change: Copy Original ® ❑ ® ❑ ❑ ❑ 57 0.61 % $ 56,738.00 0.61 % Dispersal After Approval Cecil Eastman Toy Villa