HomeMy WebLinkAboutChange Order No. 1-PCA - 2016 Curb & Sidewalk Construction Phase III - TX Concrete316 COUNIv-Crry BUILDING
227 W. JEFFERSON Bom.EVARD
Sowell BsND. INDIANA 46601-1 R30
CITY OF SOUTH BEND PETE BtJTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
December 22, 2016
Jose Quijada
TX Concrete, LLC
24899 Fillmore Road
South Bend, IN 46619
PHONE 574/235-9251
FAX 574/235-9171
RE: Change Order No. 1 (Final)/Project Completion Affidavit - 2016 Curb and Sidewalk
Construction Phase III - Project No. 116-029B
Dear Mr. Quijada:
The Board of Public Works, at its meeting held on December 22, 2016, approved the Final
Change Order for this project, loran increase of $77.21 and anew contract sum of $14,007.21.
In addition, the Project Completion Affidavit for this project was approved in the amount of
$14,007.21.
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 l
Enclosures
c:Terri Swift, Streets
Toy Villa, Engineering
GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU
..lO SOUTy gory
CITY OF SOUTH BEND, INDIANA °off
DEPARTMENT OF PUBLIC WORKS
PROJECT CHANGE ORDER 186
DATE: 11 /2112016
PROJECT NO: 116-029B
PROJECT NAME: 2016 Curb and Sidewalk Construction Phase III
CONTRACT DATE: 10/11/2016
CHANGE ORDER NO: 1 (Final)
SUBJECT OF CHANGE ORDER: PCR #1-Final Quantities
All items completed substantially as planned.
See attached Comparison of Estimate for overruns and underruns.
The original contract sum $ 13,930.00
Net change by previously authorized change orders $ 0.00
The contract sum prior to this change order $ 13,930.00
By this Change Order, the project amount is X❑ Increased
The new contract sum including this change order
This Change Order represents a total change o
Total change for entire project
❑ Decreased $ 77.21
$ 14,007.21
0.55 %
Original contracted completion date/time 11/23/2016
Extension of date/time by previous change orders 0 days
Date/time extension by this change order 0 days
New completion date/time 11/23/2016
CONTRACTOR
Co*ctor iS g a re _
! �tSL4 �U7 T !P`n6tQ 0CV AJG-e,
Printed Name aQ Tf le
TX Concrete LLC
Company Name
24899 Fillmore Road
Address
South Bend, IN 46619
City, State, Zip
0.55 %
RECOMMENDED FOR APPROVAL
C�
CONSTRUCTrION MANAGER
CITY OF SOUTH BEND
BOARD OF PUBLIC WORKS
Approved Date: 1 2� ��-
')
Gary A. Gilo , President
Suzanna M. Fritzberg, Member
Elizabeth A. Maradik, Member
Th rese J. Mrau, Member
Ja s A. Mueller, Member
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME 2016 Curb and Sidewalk Construction Phase III
PROJECT NO
CONTRACT SIGNED
PROJECT DESCRIPTION Install new concrete curb around two islands on Mishawaka Ave.
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 c
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 _ da �cci�U' 201 w TX Concrete LLC
4G rx Co e-r u c' _ Company Name
Sig ture —_ 24899 Fillmore Road
%/(6Se /er) ( Jdut9ctct -xCw Lu Company Address
Printed Name South Bend, IN 46619
City, State, Zip
WITNESS ESS: I
Bftfore me, the undersigned Notary Public in and for said country and state, personally appeared
l uls ��,and acknowledged his/her signature to the above Project Completion Affidavit on
th0'4 day of , 201.
� vkG 6GRIAE SMITH
ola Signature �� �f, My Commission Expires NOTARY PUBLic STATE OF 14DIANA
N 'i C�Zf`� O, �rr - My COMMISSION EXPIRES 1011008
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:
Secretary's Signature
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
Corporate Seal
This project is acceptable f/ojr ,fii al approval and we recommend to the Board of Public Works that it be ordained so.
Ste. Date: [ F •{ , t tb
Constructiop, pager
BOARD OF PUBLIC WORKS APPROVAL Date: �0-d-A,
Gary A. Gilot, resident Suzanne M. Fritzberg, Member Elizabeth A. Maradik, Member
Therese J. Dorau, Member Jame, A. Mueller, Member Lihda M. Martin, Clerk
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of } 5 F �l �c�_ SS:
L � Q V t t (rt is \ being duly sworn that he/she is the !S W n < t�
(Name ofOfficer) (Title)
of Tx Ctnorakc--- C- a having contracted with l L Y'l C,G 00 �k 6 C ^J e1
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows:
for a project known as
located at
and owned by
,(>
lI 1 S hawa IC �1 / A t/ -
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Dollars ($ )
❑ 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
undersigned;
(F AL WAVER) that the final balance due from the contractor is the sum of
i I Se oe J ,lug Z , ($ ) �k' 19, coo 7 e 1
❑ 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 tfls ssDpeyf this Affidavit
and Waiver of Lien.
TV (r) ar le Ig Le- C' . By (
(Firm) (Authorized Represen a ry _
STATE OF INDIANA )
) SS:
ST.JOSEPH COUNTY ) 7
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared.
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on 9Z� day of
11�� Notary Public %Oiarme
My Commission Expires: 612 7l/ 2
Residing in S O S � County, -A Notary Public, Nam
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 12/15/16
Name
Toy Villa
Department
Engineering
BPW Date
12/22/16
Phone Extension
5920
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 ❑
❑ 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
F1Other:
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
TX Concrete LLC
Pu
❑ No ❑ Yes Name of Company
2016 Curb and Sidewalk Construction Phase III
116-029B
MVH
202.0619.431.31.06
❑ Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Previous Amount $ 13,930.00
Current Percent of Change: 0.55%
New Amount $ 14,007.21
Total Percent of Change: 0.55%
Copy
Original
®
❑
❑
0
Terri Swift
Villa