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Home My WebLink AboutChange Order No 1 & PCA - Specialty Pavement Markings Proj No 117-039 - DBL Services Inc1316 COUNTY -CITY BUILDING 227 w. JFrrERSON Bouj,EVARD Soum BEND. 1NDIANA 465601-1830 CITY OF Souiii BEND PETE BurriolEG, MAY BOARD OF PUBLIC WORKS December 21, 2017 David Letcher DBL 'Services, Inc. 1811 N Clover Road Mishawaka, IN 46545 Ilr mr. 574/ 235-9251 FAX 574/ 235-91.71 RE: Change Order No. 1 (Final)/Project Completion Affidavit - Specialty Pavement Markings —Project No. 1.17-039 Dear Mr. Letcher: The Board of Public Works, at its meeting held on December 21, 2017, approved the Final. Change Order for this project, for a decrease of $1,525.85. The new Contract sum is $20,620,26. In addition, the Project Completion. Affidavit for this project was approved in the amount of $20,620.26. 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, b Y Linda M. Martin, Cleric. Enclosures c: Toy Villa, Engineering GARY A. GIl;.;o"Ir SUZANNA M. FR,I`6ZBERG Et.I;",ABETH A. MARADIK JAM.ES A. MUELLER "1"EIERESE J. DORAU h" CITY OF SOUTH BEND, INDIANA DEPARTMENT OF PUBLIC WORKS PROJECT CHANGE ORDER DATE- 11/13/2017 PROJECT NO: 117-039 PROJECT NAME: Specialty Pavement Markings CONTRACT DATE: 6/27/2017 CHANGE ORDER NO: 1 (Final) SUBJECT OF CHANGE ORDER: PCR #1 -Adjustment to Final Quantities. All items completed substantially as planned. See attached Comparison of Estimate for overruns and underruns. The original contract sum Net change by previously authorized change orders The contract sum prior to this change order By this Change Order, the project amount is 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 Extension of dateltime by previous change orders Date/time extension by this change order New completion date/time CONTRACTOR Contractor Signature -ei- c,.,, L� v I U � L�, e Printed Name and Title DBL Services, Inc. Company Name 1811 N. Clover Rd. Address Mishawaka, IN 46545 City, State, Zip $ 22,146. 11 $ 0.00 $ 22,146.11 Increased' n Decreased $ 1,525.85 $ 20,620.26 6.89 % 6.89 % 9/20/2017 0 days 0 days 9/20/2017' RECOMMENDED FOR APPROVAL. \Alt CONSTRUN MANAGER rqffiilro11 BOARD OF PUBL!,C )A/?RKS., Approved Date: Gary A. Gilot:, Presid'ent Suzanna M. Fritzberg, Member Elizabeth A Maradik, Member Therese J. Do(au, Member Jam/ s A. Mueller, Member V CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME -Specialty Pavement Markings PROJECT NO 117-039 FINAL COST $20,620.26 CONTRACT SIGNED, 6/27/20l17 MAINTENANCE AGREEMENT ENDS Restri:lpe existing transverse and specialty pavement markings within the City of PROJECT DESCRIPTION South Bend. 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 ail 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 201 DBL Services, Inc. It d thi� AU��. day of Company Name Signature 1811 N. Clover Rd. 0 L, Company Address Printed Name Mishawaka, IN 46545 City, State, Zip WITNESSESS: Before me, the undersi ed Notary Publilic in and for said country and state, personally appeared l r D L IT, and acknowledged his/her signature to the above Project Completion Affidavit on the 5 f/A day of be,e,&Mh,,C -, 2017 . ....... . My Commission Expires Notary Signature A'vii fu Printed Name County of Residence J#se-vk I If the Contractor is a corporation, the following certificate will be executed. 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 Corr) ration by Authority of its governing body, and is within the sc of Coll, r Doriii:: to ol c MEREDITH REIF 14wary Public, State of Indiana Saint Joseph County Secretary's Signature SEA Commission # 639359 Corporate Seal My Commission Expires mOctober23,F202O Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable fo fi I approval and we recommend to the Board of Public Works that it be ordained so. �T I Date: Construction a * Gary A. Gilot, President Th6rese J. Dora,u, Meifiber BOARD OF PUBLIC WORKS APPROVAL Date: I, ) 2, ( L (-,) I � Suzanna M. Fritzberg, Member Elizabeth A Ivlaradik, Member Final Waiver of Lien (State of Indiana, County of l) �e SS; being duly sworn that he/she is the I L4 � n 9 O. (� (Name of Officer) (Title) of having contracted with (Contractor) (Owner) to furnish certain materials and/or labor as follows; VAN).e� ' V'� t vv (Description) for a project known as Li (Name ofProjeot) located at Y-%Gv and owned by C' -T `/ 0 r (Owner) and does hereby further state on the behalf afthe aforementioned subcontractor/supplier; (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars . ❑ receipt of which is hereby acknowledges]; or ❑ tits payment of which has been promised as the sole consideration for this Affidavit and Pined Waiver of Lien -which is given solely with respect to said amount and which waiver sball be effectivo only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sure of _($ ) [� receipt ofwhiah is hereby acknowledged; or ❑ thepayment of which, has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shelf l become effective only upon receipt of such payment. l 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 ormaterial or both, Iiu'nishe-d b the undersigned theroto, subject to limitations or ooladitions expressed herein, if any, and ft'ther certified that no other party has any claim or right to a lien on account of any work performed or material tumished to the un€dersi far said r at d wit in scope of this Affidavit j and Waiver of Lien. By (Firm) (Authorized Representative) STATE OF INDIANA ) SS: ST, JOSEPH COUNTY 136fore me, the undersigned, a Notary Public, In and for said County and State, personally appoared Ploy; V I�Y- and acknowledged the execution of the :Foregoing Affidavit and Waiver of Liens. W TNLSS 'WJfIMOF, Ihave hereunto subscribed my name and affixed my official seal on the �h day of j Notary Mile Signature My Commission Expires; 0r 11 i Residing in -, Jb S e-Cauuty, �n L4L ` et ►2E FgtitryPab � H REIF 3 Notary Public, tale of Indiana Saint Joseph County sEnc : Commission to 639359 My Commission Expires i October 23, 2020 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12,/12/17 Department Public Works Name Toy Villa Division/Bureau Engineering BPW Date 12/21/17 Phone Extension 5920 Legal M Attorney Name: Controller El 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 E] Check the Appropriate Item Type - Required for All Submissions 0 Agreement F-1 Contract ❑ Proposal ❑ addendum F Professional Services Resolution F-1 Bid Opening ❑ Bid Award 0 Req. to Advertise Title Sheet Quote Opening F-1 Quote Award Change Order No. C/0 & PCA NoJ (Final) ❑ PCA El Ease/Encroach. ❑ Traffic Control: F Other: Company or Vendor Name New Vendor MBEA/VBE Contractor MBEANBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description DBIL Services, Inc. 0 Yes 0 No El If Yes, Approved by Purchasing MBE F1 WBE No 0 Yes Name of Company Specialty Pavement Markings 117-039 LRSA 251.0608.431,42.93 Project. Closeout [:1 Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. Amount of El increase $ E Decrease $ 1,525.85 Previous Amount $22,146.11 Current Percent of Change: 6.89�% New Amount $20,620.26 Total Percent of Change: 6.89% Copy Original R R F-1 R El El