HomeMy WebLinkAboutChange Order No 2 & PCA - Main St at Washington St Roadside Improvements Proj No 116-001A - Premium Concrete Services Inc1316 COUNTY-0i'y BUILDING
227 W. Jl.-TFERSON BoullVARD
Souni BEND, INDIANA 46601-1830
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
December 21, 2017
Becky Yeakey
Premium Concrete Services, Inc.
712 Richmond Street
Elkhart, IN 46516
PHONE 574/235-9251
FAX 574/ 235-9171
RE: Change Order No. 2 (Final)/Project Completion Affidavit - Main Street at
Washington Street Roadside Improvements — Proj ect No. 116-001 A
Dear Ms. Yeakey:
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 $9,571.50. The new Contract sum is
$107,46L50.
In addition, the Project Completion Affidavit for this project was approved in the amount of
$107,461.50.
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
c: Toy Villa, Engineering
Roger Nawrot, Engineering
GARY A. GILOT SUZANNA M, FRITZBERG ELIZABETi-i A. MARADIK JAMEs A. MUELLER THERESE J. DORAU
CITY OF SOUTH BEND, INDIANA
DEPARTMENT OF PUBLIC WORKS
PROJECT CHANGE ORDER
- - - - - - - - - -
DATE: 10/1/2017
PROJECT NO: 116-001A
PROJECT NAME: Main Street at Washington Street Roadside Improvements
CONTRACT DATE: 7/11/2017
CHANGE, ORDER NO: 2 (Final)
SUBJECT OF CHANGE ORDER: PCR #2-Adjustment to Final Quantities
All items completed substantially as planned.
See attached Comparison of Estimate for overruns and underruns.
The original contract sum
$
115,833,00
Net change by previously authorized change orders
$
1,200.00
The contract sum prior to this change order
$
117,033.00
By this Change Order, the project amount is increased
Decreased
$
9,571.50
The new contract sum inclluding this change order
$
107,461.50
This Change Order represents a total change of
-8.18 %
Total change for entire project
-7.23 %
Original contracted completion date/time
Extension of date/time by previous change orders
Date/time extension by this change order
New completion date/time
ONTR /CT
6ntractorig,A4ur
13(e&"/
Printed NFame and Title
Premium Concrete Services, Inc.
Company Name
712 Richmond Street
Address
Elkhart, IN 46516
City, State, Zip
.8,/25/2017
28 days
0 days
9/22/2017
RECOMMENDED FOR APPROVAL
CONSTF� ION MANAGER
CITY OF SOUTH BEND
BOARD OF PUBLIC WORKS
Approved Date:
Gary A. Gilot, President
Suzanna M. Fritzberg, Member
Elizabeth A Maradik, Member
Therese: J. Dorafi, M461ber
JaJes A. Mueller, Member
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME -Miain Street at Washington Street Roadside Improvements
PROJECT NO 116-OOIA FINAL COST $107,461.50
CONTRACT SIGNED 7/11/2017 MAINTENANCE AGREEMENT ENDS
Roadside improvements in the northwest quadrant of the intersection of Main Street &
PROJECT DESCRIPTION Washinaton Street.
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 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,
4
Ex ed, thi dgf 1201 -1 Premium Concrete Services, Inc.
Company Name
IR Z.-
Aidb t-ulre � 712 Richmond Street
Company Address
Printed Nam el Elkhart, IN' 46516
City, State, Zip
WITNESSESS:
, Before methe undersigned Notary Public in and for ppeared
,5r :CX VCAXE V, and acknowledged his/her si t t?, VOFr Com letion Affidavit on
aNN'Sootary knitna
the t—f day of PfLELq&6JL, 201 '1 my 00m E; 1. KHART County
, s� "o,
My Commission Expires 0412412024
Notary Signature My Commission Expires
A 1-,e I dLA 'aWC& S
Printed Name County of Residence
If the Contractor is a, cprpation, the following certificate will be executed,
I, ftv Ke-' Yt V certify that I am Secretary of the Corporation executing this release; that
L'4 who signed this release on behalf of the contractor was then
FIE �f We of said Corporation; that said release was duly signed for and on behalf of said
Corporation uthority of its governing body, and is within the scope of corporate powers:
$Wrd'Cry's Signature Corporate Seal
MAV! /�-
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is prova an acceptable for I rI d we recommend to the Board of Public Works that it be ordained so.
C
Date:
Construction V�9'Tger
Gary A. Gilot, President
BOARD OF PUBLIC WORKS APPROVAL Date:
S,uzanna M. Fritzberg, Member
Therese J. Derau, Mdtuber Jame A. Mueller, Member
Elizabeth A Maradik, Member
066 M. Martin, Clerk L
MAINTENANCE BOND
KNOW ALL MEN BY THESE PRESENT&
Bond No. MNT2156816
That Premium Concrete Seryices, Inc_712 Richmond St. Elkhall. M 46516-
as Principal, hereinafter call Contractor, and Old Republic Insurance Company
Brookfield, W! as Surety, hereinafter call Surety, are held and firmly bound unto
City of South Bend Board of Public Works , as Obliges, hereinafter called Owner, in the penal sum of
$10,746.15 for the payment whereof Contractor and Surety bind themselves, their heirs, executors,
administrators, successors, and assigns, jointly and severally, firmly by these presents.
WHEREAS, Contractor has by written agreement, dated July 11, 2017 1
entered into a contract with Owner for Main Street at Washington Street Roadside Improvements; Project No. 116-OOIA I
in accordance with the General Conditions, the Drawings and Specifications, which contract is by reference incorporated herein,,
and made a part hereof, and is referred to as the Contract.
NOW, THEREFORE, the condition of this obligation is such that, if Contractor shall remedy any defects due to faulty materials or
workmanship, and pay for any damage to other work resulting therefrom, which shall appear within a period of �_year(s)
from the date of substantial completion of the work provided for in the Contract, then this obligation to be void; otherwise to
remain in full force and effect.
Bond shall be effective from December 1, 2017 to December 1, 2020,
PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable promptness.
SIGNED and sealed this 4th day of December _t 2017
Premium Concrete Services, Inc.
Principal
Bv (Seal)
Titte 0-
&ZLI
Old Republic Insurance Company
By
(Seal)
Jennifeyt, asznia Aft6rniey /1'0 act
01,A)REPUBIAC INSURANCE COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does
make, constitute and appoint:
NICOLE L BICKNELL, MEGAN E RI:ESENBERG, MARK EDWARD WOBBE, DEBRA K HULL, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK,
WILLIAM J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEMER, OF SOUTH BEND, IN
its true and lawful Attorneys) -In -Fact, with full power and authority, not exceeding $60,000,000. for and on: behalf of the Company as surety, to execute
and deliver and affix the seal of the Company thereto (if a seal Is required), bonds, undertakings, recognizances or other written obligations In the nature
thereof, (crljc;ur flrmn s0 insurance workers compemsation boirx'he ' payment of benefits, asbestos abakirnent corAract bonds, waste maneige:
inEmt. bonds, hazmdoims, waste rernedlafion boraces or black lung b&CIS), as follows:
ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED
FOUR MILLION DOLLARS($4,000,000) ....................... FOR ANY SINGLE OBLIGATION.
and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attorneys-! n-Fact, pursuant to these presents, are ratified and
confirmed. This document is not valid unless printed on colored background and is multi -colored. This appointment is made under and by authority of
the board of directors at a meeting held on March 14, 20% This Power of Attorney Is signed and sealed by facsimile under and by the authority of the
following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on March 14, 2014,
RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surety division, In, conjunction with the secretary or
any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of
the Company may deem appropriate, Powers of Attorney in the, form presented to and attached to the minutes of this meeting, authorizing such
persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recortzances, and, surVshlf obligations of all kinds,
other than ball briindsi, bmik depos�Cory bod nds, movtgage c.�,fk,1ay w,,,bon= ds, r1gage W,mranty .)onds, guarantees of ens allment paper and note
gluaranty bonds The said officers may revoke any Power of Attorney previously granted to any such person. The authority of any Power of
Attorney granted by any such officer of the Company as aforesaid shall not exceed fifty million dollars ($50,000,000.00), except (a) bonds
required to be filed as open penalty bonds, and (b)bonds filed with any court or governmental authority requiring an unlimited penalty in bonds
filed In that court
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
(1) when signed by the chairman, president or any vice president of the Company's surety division and attested and sealed (if a seal be
required) by any secretary or assistant secretary; or
(it) when signed by a duty authorized Attorney -in -Fact and sealed with the seal of the Company (If a seal be required),
RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any
Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship
obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed,
IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by Its proper officer, and its
corporate seal to be affixed this 2 9TH day of _,_7ULY 2016.
OLD REPUBLIC INSURANCE COMPANY
�0 4,
C,
AM
SEAL
0
STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS 111palwo Vice President
On this 29TH day of JULY, 2016 _, personality came before me, ALAN PAVLIC and
JANE E CHERNEY — to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who
executed the above Instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that
they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate
seat and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said
organiizatio,n,
V/
'Notary Public
My commission expires: 9/28/18
CERTIFICATE (Expiration of notary commission does not invalidate this Instrument)
111, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing
and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in
the Power of Attorney, are now in force.
45-5314
Signed d sealed at the City of Brookfield. W1 this day of,
SEAL
I 1006-R (5-10)
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of SSA
being duly sworn that he/she is the
;?Name of Officer) f it
(Title)
of 44- having contracted with
(Subcontractor/Supplier) (Contractor)
to furnish certain materials and/or labor as follows.
for a project known as rflou"i(-
located at
and owned by
(Owner)
(Description)
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 ($
M receipt of which is hereby acknowledged; or
M
El 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;
FINAL WAIVER) that the fin balance due fro the contractor is the a
ke 'o
A'C �t 1,
StlqL 'a ya
85
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 prject, and ithin the scop
and Waiver of Lien. Z-) of this Affidavit
-W Zaw 'WI V Vr W �'v � �w
0"W'w
(Finn)
PATRICIA A 'BOWERS (A4thotizerepres'enfati Notary
Slate of IndanC'
STATE OF INDIANA ry Public Sea] State of Indiano
M ary "'0 "a
SS: ELK�HART County
ST. JOSEPH COUNTY My Commission Expires 04/2412024
Commission
iC
W L . MV U v
Before me, the undersigned, a Notary ub 'c, in an or said County and State, personally appeared K, eiq*5f
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. I g
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the day of
Eaefillb C-C 20X 11,
Notary Public Signature
My Commission Expires: L-po-�? o
Residing in ELK116e7- county,_ Not Public Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 12/12/17 Department
Name Toy Vi11W Division/Bureau
Public Works
Engineering
BPW Date 12/21/17 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 El
❑ Agreement Amendment H Contract H Proposal Addendum
Professional Services El Resolution
❑ Bid Opening F-1 Bid Award ❑ Req. to Advertise El Title Sheet
❑ Quote Opening F-1 Quote Award
El Change Order No. Z C/O & PCA No.2 ffinal) F-1 PCA
F] Ease/Encroach. F-1 Traffic Control:
F-1 Other:
Company or Vendor Name
Premium Concrete Services, Inc.
D Yes F1 No Ll If Yes, Approved by
New Vendor
Purchasing
MBEANBE Contractor
0I MBE F] WBE
MBE/WBE Contractor Requested F-11 No 0 Yes Name of Company
Project Name
Main Street at Washington Street Roadside Improvements
Project Number
116-001 A
Funding Source
TIF Bond
Account No.
Amount
$
Terms of Contract
Purpose/Description
Project Closeout
n Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Required For Change Orders Only -
Amount of E] increase $
M Decrease $9,571.50
Previous Amount
$ 117,033.00
Current Percent of Change:
8.18 %
New Amount
$ 107,461.50
Total Percent of Change:
7.23%
Copy
Original
E
F-1 Roger Nawrot
M
F-1 Toy Villa
�
El