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Home My WebLink AboutChange Order No 1 & PCA - Cleveland Well Refurbishments – Well Cleaning Proj No. 118-021C - Peerless Midwest1316 COUNTY -CITY BUILDING PHONE $74/ 23$-92$1 227 W. JEFFERSON BOULEVARD ,�,', 15��x( FAX 574/ 235-9I7I SO] ITH BEND_ INDIANA 4660I -I 930 i 7 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARDF PUBLIC WORKS December 19, 2019 Mr. Frank Williams Peerless Midwest 55860 Russell Industrial Pkwy. Mishawaka, IN 46545 RE: Change Order No. 1 (Final)/Project Completion Affidavit — Cleveland Well Refurbishments — Well Cleaning — Project No. 118-021C Dear Mr. Williams: The Board of Public Works, at its meeting held on December 19, 2019, approved the Final Change Order for this project, for a decrease of $402. The new Contract sum is $48,598. In addition, the Project Completion Affidavit for this project was approved in the amount of $48,598. 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 GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU CITY OF SOUTH BEND DEPARTMENT OF PUBLIC WORKS PROJECT CHANGE ORDER DATE: PROJECT NO: PROJECT NAME: CONTRACT DATE: CHANGE ORDER NO. SUBJECT OF CHANGE ORDER: 11 /22/2019 ....... Cleveland Well Refurbishments Well Cleanin 1..�......w........................................ _....�.�...... Decrease in final project amount due to allowance cap not met _of Estimate for overruns and underruns. See attached Comparison _.-..._...... _ ...w_ ...... ....w The original contract sum $ 49,000.00 Net change by previously authorized change orders $ 0.00 p g .......�...... The contract sum prior to this change order $ 49,000.00 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 .. ...... Contractor Signature Frank Williams Printed Name and Title Peerless Midwest, Inc. Company name�� 55860 Russell Industrial Parkway Address--..._ . Mishawaka IN 46545 City, State, Zip ❑ Increased 402.00 ® Decreased $ $ 48,598.00 0.8 % 90 calendar 90 calendar RECOMMENDED FOR APPROVAL CONS" l' Chi MANAGER C°I"I�"tSOUTH BEND BOARD OF PUBLIC WORKS Approved Date: �v( $ "ary A. Gilot, P�resideni........ ...�... Genevi eve E. Mille aN Member l� Mar��lil�...� ..._�_.� Elizabeth t , Mcmbe Therese . DAuM ber .�rra O'Sullivan, Member m ia7a o,yt CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS ; PROJECT COMPLETION AFFIDAVIT PROJECT NAME Cleveland Well Field Retrvtn-bishn,ient _ Well Cleaning PROJECT NO i 18-021C FINAL COST $48,598.00 CONTRACT SIGNED 091/10/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION __SLJeaqin& ini ection rehabilitation, atL4not r re laceniei lrc�r Well 5 at � levelacl WITNESSETH: North Well Field. 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. Executed this 10th day ofDecember, 2019 Peerless -Midwest, Inc. 'A Company Name Signature 55860 Russell Industrial Parkway James R. Williams Company Address Printed Name Mishawaka IN.: 46545 City, State, Zip WITNESSESS: B f re, H e the �undtersigned Notary Public in and for said country and state, personally appeared J e R Wi 1 i ama and acknowledged his/her signature to the above Project Completion Affidavit on the th �� air of Deco bed, 2019. .,.. �WAWNYtN,�rjf� �wyre,r: CATHY S. LANCE No ry Signature My Commi - 1� or Indiana Notary State X„ m `i aE* Y x pty Printed N y Expires Cat Name Ldnce Count of commission E If the Contractor is a corporation, the following certificate will be executed, I, Michael J . Williams certify that I am Secretary of the Corporation executing this release; that James Williams who signed this release on behalf of the contractor was then General manager of said Corporation; that said release was duly signed for and on behalf of said Corporation b ,Authq i't, o its governing body, and is within the scope of corporate powers: WKI � Secretary' gnature Michael J. Williams Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable f r at approval and we recommend to the Board of Public Works that it be ordained so. Date: Constructi 9111 ager .. Gary A. GiIoPr�esident x Therese J. d4fau, Mernber BOARD OF PUBLIC WORKS APPROVAL E. Miller, Date: Elizabeth A. Maradik, Member nda M. Martin, Clerk AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of Janes R . Williams �ITIT p being duly sworn that he/she is the General Manager (Name of Officer) - (Title) of Le nc.� having contracted with City of South Bend Dept. Of Public Works (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: Cleveland Well Fimmeld Refurbishments -Well Cleaning,. (Description) for a project known as Project 118-021C Cleveland Well Field (Name of Project) located at Cleveland Well Field and owned by C i� 0 f 1i t h B l 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, _�. El receipt of which is hereby acknowledged; or 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; HE WAIVER) that the final balance due from the contractor is the sum of 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 Marty has any claint 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 and Waiver of Lien. Peerless -Midwest Inc. By ' (Firm) (Authorized Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared James R . Williams and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my off '4sealce 1 h day of December 200 1g CATHY S LANCE a Notary Public, State of Indiana otarnature nary tc«ter St. Joseph County My Commission Expires: "w. Z fly Commission Expires d A++un� a Residing in Cathy S . Lance �.,.�k �..., t . Joseph n a Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/17/2019 To Villa Department Engineering Name....__........ .._�....�...�... _._.. ..... ........ .... BPW Date 12/19/2019 Phone Extension 5920 Required Prior to Submittal to Board BPW Attorney F] Attorney Name Dept. Attorney ❑ Attorney Name Purchasing Check the Anix-ornate Item Tvoe - Reenoil) U Professional Services Agreement H Contract F1 Open Market Contract ❑ Amendment/Addendum Bid Opening ❑ Bid Award Quote Opening E] Quote Award Proposal Opening ® C/O & PCA No. Chg. Order, No. ❑ Traffic Control Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description All Submissions LJ Proposal ❑ Special Purchase, QPA ❑ Req. to Advertise Reject Bids/Quotes ❑ PCA ❑ Resolution Ease./Encroach ❑ Title Sheet Peerless Midwest �... --------- .......... --- ........ ❑ Yes If Yes, Approved by Purchasing No MBE MBE Completed E-Verify Form Attached El Nos Cleveland Well Field Refurbishments - Well Cleaning ....._......_. ......... 118-021 C Riverwest TIF 324.1050.460.42.02 $48,598.00 Project Closeout ........ For Chas g Orders QrIl "�_____-..__:..._.. Amount of ❑ Increase $ ® Decrease ($ 402.00) Previous Amount $ 49,0010,00 Increase Current Percent of Change: Decrease New Amount $ 48,598.00 Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: 80%) 0.80%)