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Home My WebLink AboutChange Order No 1-PCA - Ziker Sample Street Bldg Restroom Remodel Project No 117-123 - Premier I Construction IncPHONE 574/235-9251 FAx 574/235-9171 1t6 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS December 11, 2018 Al Lusk Premier I Construction, Inc. 105 E. Jefferson Blvd., Suite 216 South Bend, IN 46601 RE: Change Order No. 1 (Final)/Project Completion Affidavit - Ziker Sample Street Building: Restroom Remodel — Project No. 117-123 Dear Mr. Lusk: The Board of Public Works, at its meeting held on December 11, 2018, approved the Final Change Order for this project, for a decrease of $3,782. The new Contract sum is $19,978. In addition, the Project Completion Affidavit for this project was approved in the amount of $19,978. 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 CITY OF SOUTH BEND, INDIANA, DEPARTMENT OF PUBLIC WORKS PROJECT CHANGE ORDERx " DATE: 12/26/2018 PROJECT NO: 117-123 PROJECT NAME: Ziker Sample Stret Buildin : Restroom Remodel CONTRACT DATE: 8/14/2018 CHANGE ORDER NO: 1 Final SUBJECT OF CHANGE ORDER: PCR #1-Ceilingand Floor Credit 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 date/time by previous change orders Date/time extension by this change order New completion date/time CONTRACTOR Con t Si lore IJS 6CTAe�t Printed Name and Title Premier 1 Construction„ Inc. Company Name 105 E. Jefferson Blvd, Suite 216 Address South Bend, IN 46601 City, State, Zip Increased X Decreased 11 /18/2018 0 days 0 days 11/18/2018 23,760.00 0.00 23„760.00 3,782.00 19,978.00 -15.92 % -15.92 % r E!!IQVAL AGER��I lid rrJi IY III CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Approved Dak.: Y,0 ! ~ Gary A. Gilot, President lSuzan5nM�l.Fritzber , Member Elisabeth A. Maradik, Member Therese J, Do u, Member James A. Mueller, Member ;rtiMrre �n CITY OF SOUTH BEND, INDIANA °� BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Ziker Sample Stret Buildin : Restroom Remodel PROJECT NO 117-123 FINAL COST $19„978.00 CONTRACT SIGNED 8/14/2018 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Remodel and installation of one new restroom, 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 or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City the , f Executed d 0 South Bend whichwhichwere o part f e above Contract 201 _f Premier 1 Construction, Inc. Company Name Signature 105 E. Jefferson Blvd, Suite 216 Company Address Printed Name South Bend, IN 46601 City, State, Zip WITNESSETS: Before me, the undersigned Notary Public in and for said country and state, personally appeared and acknowledged his/her signature to the above Project Completion Affidavit on the... _4�'i1 day of 0 201_1 to A Siggnature My Commission Expires Printed Name County of Residence 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 Corporation by Authority of its governing body, and is within the scope of corporate powers: Tdla kNl id 1'wl Mile Notary Secretary's Signature "��" — %�"� Public " Corti n. �Expires Aires ng 3�.1,, 202�orporate Seal 1 Rosides ln& 1osepl, ccw., IN • Comniu Nua tm 67237 Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for in pproval and we recommend to the Board of Public Works that it be ordained so. Date: - 1 Construction ger BOARD OF PUBLIC WORKS APPROVAL Dater Gary A. Gilot, President Suzanna M. Fritzberg, Member Eliza eth , a;radik, Member M Therese J. D rau, M67i5ber H James A. Mueller, Member I_' daM. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of SS: ,F� _ m g duly sworn that he/she is the 1 '& t a O-J V (Name of Office,........ n�..............� _.�. ..�.. �_� . r) (Title) �, .�..e.. of 'eA- _ having contracted with U-P �.. Subcontr to0Su leer ( pp ) CC? rclCr4?1 to furnish certain materials and/or labor as follows; .�.�Dcst.ir �tio� ..... _..rc � . � .� ..�.�� ... for a project known as f� ( 1 .�) /� n ....W. �.�.... ._....� ........ _ 12 _ �� (Name of Project) located at w ..w...,. _ and owned b e f _ (Owner) 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; (FINAL WAIVER) that the final balance due from the contractor is the sum of r � l ❑ 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 the scope of this Affidavit river of Lien. ..................... (Firm) Catrrirr7��x r rf �A�i 31 art P IC( axed Mega-eseatative) STATE OF INDIANA ) Y i SS: Re,ides in S. Jo,epfr Co., 6N ST. JOSEPH COUNTY ) R 4�r�a. Nudrn�er 672377 Before me, the undersigned, a Notary I'ubltc„ in ari or sai ounty and State, personally appeared an IN IT"ed the execution of the foregoing WHEREOF, I have hereunto subscribed my name and affixed my official seal on the 2� ^day of acknowledged Affidavit and Waiver of Lien. INj200 Notary Public Signature My Commission Expires: 'Akq Residing in I V County, t V ............. ........ Notary � ... Public Name �_ �........ o ary me BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/04/18 Name Toy Villa ` Department Engineering BPW Date 12/11/18 Phone Extension 5920 N �" '�� N6/lMWNIIIIIIIIIYIYIYW WWNV.WNIP7INYPIWYW IY'w. .. .,w.�............... �........�......,.,........ mm.,.,�.,�....�..�....�.�,.......�................,-�.�.�.�....�..�.�..,�. Re.quired 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 Check the LJ Agreement ❑ Professional Services ❑ Bid Opening ❑ Quote Opening ❑ Change Order No. ❑ Ease/Encroach. F-1 Other: Company or Vendor Name New Vendor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description rro riate Item Type — Requi, [ Contract Resolution Bid Award ❑ Quote Award ® C/O & PCA No. 1 Final El Traffic Control for All Submissions ❑ Addendum ]'Proposal ❑ Req. to Advertise ❑ Title Sheet Required Information ❑ PCA Premier 1 Construction, Inc. __...-...wwwwww...ww MBE �] W � If Yes, Approved y Purchas — _---_B E Ziker Sample Street Building Restroom Remodel 117-123 River West TIF 324-1050-460-42.02 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.. uired For Change Orders On El increase $ Amount of Decrease $ m3„7820 Previous Amount Current Percent of Change* 15.92...._�____..........._ New Amount $19��,��978.00�� Total Percent of Change: 15.92% Dispersal After Approval Copy Original ❑ ❑ ❑ ❑