HomeMy WebLinkAboutChange Order No 2 & PCA - Mishawaka Avenue Traffic Signals at Fire Station No. 9 Proj No. 117-120A - Pemberton Davis Electric, Inc.1316 COUNTY -CITY BUILDING J
, i PHONE 574/ 235-9251
227 W. JEFFERSON BOULEVARD
FAX 574/ 235-9171
SOUTH BEND. INDIANA 46601-19-10
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
December 19, 2019
Mr. Tanner Leibovitz
Pemberton -Davis Electric, Inc.
916 E. McKinley Ave.
Mishawaka, IN 46545
RE: Change Order No. 2 (Final)/Project Completion Affidavit — Mishawaka Avenue Traffic
Signals at Fire Station No. 9 — Project No. I I7-120A
Dear Mr. Leibovitz:.
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 $15,777.37. The new Contract sum is $172,146.57.
In addition, the Project Completion Affidavit for this project was approved in the amount of
$172,146.57.
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,
L fiida M. Martin. Clerk �
Enclosures
GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU
CITY OF SOUTH BEND, INDIANA���"
DEPARTMENT OF PUBLIC WORKS,
�ut
PROJECT CHANGE ORDER�
�
ro
f.lJ�1✓J""�.77
DATE: 1 /9/2020
PROJECT NO: 117-120A
PROJECT NAME: Mishawaka Avenue Traffic Signals at Fire Station #9
CONTRACT DATE: 2/26/2019
CHANGE ORDER NO: 2 Final
SUBJECT OF CHANGE ORDER: PCR #4-Final Quantities
All items completed substantially as planned.
See attached Comparison of Estimate for overruns and underruns.
The original contract sum
$
171,285.37
Net change by previously authorized change orders
$
16,638.57
The contract sum prior to this change order
$
187,923.94
By this Change Order, the project amount is Increased
W Decreased
$
15,777.37
The new contract sum including this change order
$
172,146.57
This Change Order represents a total change of
-8.40 %
Total change for entire project
0.50 %
Original contracted completion date/time 7/17/2019
Extension of date/time by previous change orders 0 days
Date/time extension by this change order 0 days
New completion date/time 7/17/2019
CONTRACTOR
Contractor Signature CONSTFOMON
MANAGER
TANNER LEIBOVITZ CITY OF SOUTH BEND
Printed Name and Title
Pemberton Davis Electric, Inc.
Company Name
916 E. McKinley Avenue
Address
Mishawaka„ IN 46545
City, State, Zip
BOARD OF PUBLIC 0'
KS
Approved Date: J ao
Gary A. Gilot, President
Genevi a E. Miller, Member
uk.
Elizabeth A. Maradik, Member
J'*
L. O'Sullivan, Member
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS f �. ;1Q ` 4
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Mishawaka Avenue Traffic Signals at Fire Station #9
PROJECT NO 117-120A FINAL COST $172,146.57
CONTRACT SIGNED 2/26/2019 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Installation of preemptive systems at Mishawaka Ave/Ironwood Dr for Fire Station #9
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
of South Bend which were a part of the above Contract.
Exe uted this 14 day of )6rk4e^111l 2019 Pemberton Davis Electric, Inc.
Company Name
ignature 916 E. McKinle Avenue
a e� O Company Address
Printed Name Mishawaka, IN 46545
City, State, Zip
WITNESSESS:
Before me, the undersigned Notary Public in and for said country and state, personally appeared
=fb►W and acknowledged his/her signature to the above Project Completion Affidavit on
the TN da of hgXd5 &g 201 q
Notary Signature My Commission Expires
Printedd tme County of Residence
If the Contractor is a corporation, the following certificate will be executed.
I<ELLY M HAIMBAUGH
Not Public, State of Indiana
a
St Joseph County
V1y Commission Expires
February 02, 2020
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
Corporate Seal
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable «f al approval and we recommend to the Board of Public Works that it be ordained so.
F"oft �
Date: �.:. __ • 1
Constructio anager a
BOARD OF PUBLIC WORKS APPROVAL Date:
Gary A. Gilot, President GeneviiQE. Miller,, We—)We!rizabetti A. Mara ik, Member
Therese J. Dorau, Member L90fa L. O'Sullivan, Member Li da M. Martin, Clerk
Final Waiver of Lien
State of Indiana, County of _ SS:
being duly sworn that he/she is the
(Name of Of -Boer) (Title)
Of AC - )04-'-4 having contracted with City of South Bend ---
(Contractor) (Owner)
to furnish cettain materials and/or labor as follows:
(Description)for a project known as M13�"0.^^t 4r sti 9
'^ y► (,Name ofPrgject)
located at ► "�� s'Vt`' AL, cLJ`��t„ �boS2. JQN
and owned by ON of South Bend
(Owner)
and does hereby further state on the behalf ofthe aforementioned subcontmact"Aupplien
(,PARTIAL WAIM) that there is due from the Contractor the suns of
Dollars ,.
❑ rccoipt of which is hereby owfodged; or
❑ the Payment of which has been promised as the sole consideration, for this Affidavit and Final Waiver of Lion which is given
solely with respect to said amount, and which waives shall be effective only capon receipt ofpayment thereof by the
undersigned;
(I'INAL WAIVER) that the final balance due from the contractor is the urn of
it j ot, n ac i V� "
❑ receipt of which is hereby acknowledged; or
® ilia payment of which has been prom isod as the sole consideration forthis Affidavit and Final Waiver of Lien which shall
became effective only upon roceipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever
on the above-deserlbed property and improvements theroon a& account of labor or mnaterial or both, hunished b time undersigned
thereto, subject to limitations or conditions expressed heroin, if any; .and f%tthor certified that no other party has any claim or right to a
Ron on account of any work perfonned or material t rrnishod to the undersigned for said project, and within the scope of this Affidavit
and Waiver of Llem
(F) thorxod nalvo
STATE OF IDIANA Am
SS:
ST. JOSBPH COUNTY )
Before me„ the undersigned, a Notary public, in and for said County and State, personally appeared TQA,
and acknowledged the oxemidon of the foregoing Affidavit and Waiver of Lien.
IN W1T, 'l3SS 1tSOF, I have hereunto subscribed my narne and affixed my official soot on e _ 11,7W day of
201
Nq Pu I c Sigrreturo
My Commission Expires:
Residing in County, r �rtr ub loCaaro u o s , ea
g, My P xpr re s
�r�rvuasw,i;�u i�aw tixaaa.
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 12/17/2019
Name T�llaDepartment: Engineering
....... . ........................... . ... . . . ................ . ..... ____ ...........
BPW Date 12/19/2019 Phone Extension 5920
Required Prior to Submittal to Board
BPW Attorney El Attorney Name
Dept. Attorney
Purchasing
X7
E]
Check the A
Attorney Name
Item TvDe —
H Professional Services Agreement H Contract
R
Open Market Contract
Amendment/Addendum
[J
Bid Opening
Bid Award
❑ Quote Opening
Quote Award
❑
Proposal Opening
C/O & PCA No.2(Final)
Chg. Order, No.
Traffic Control
F� Other:
All Submissions
F1 Proposal
E] Special Purchase, QPA
E] Req. to Advertise ❑ Title Sheet
Reject Bids/Quotes
❑ PCA
FJ Resolution
Ease./Encroach
Company or Vendor Name
Pemberton -Davis Electric, Inc.
. . . . . . ...... . ........ . . ............ . ........ . . ....................... .. . . . ...... . . ..................................... . . . . . ............. .. . . . ................................................................ . ..........................................................
E] Yes E] If Yes, Approved by Purchasing
New Vendor
Z No
MBE M Yes
MBE/WBE Contractor
Completed E-Verify Form Attached
WBE ❑ No
Project Name
Mishawaka Avenue Traffic Signals at Fire Station #9
Project Number
117-120A
... ... ........ ....................
Div. A — LRSA Traffic Signal Maintenance / Div. B — EMS Capital
Funding Source
Fund
Account No.
251.0608.431.36.67 / 287.0902.422.42.02
.. . . . . . .......... - . . . . .. ........... ........................................................................................................................................ . . . . . . . . . . . . . . . . . . . . . . . ....... .. ....... .. ............ .. ...............................
Amount
Terms of Contract
Purpose/Description
Project Closeout
For Chanize Orders OnI
Amountof 1:1
Increase $ ................... ......................... ............................ . ...................
Z
Decrease ($15,777.37)
Previous Amount
$ 187,923.94
Increase %
Current Percent of Change:
Decrease _(�.40.0
. .......... . . .........
New Amount
$ 172,146.57
......................... . . ................ . . . _. ............ ..... . . . . . . . ................................. ..... ................................... ...................................... . . . . . .................... . ...............
Increase %
. ................... . ................................ . ................ . . ...........
Total Percent of Change:
Decrease
Time Extension Amount:
. . ..... . ........— ------ . . .............. . ..... .... ...... . ........ . . . .............................................
New Completion Date:
....... . . ...... . . . ............ - . . Completion . . ...............................................................
. _.._._ . ............................. ........... _.___ . . ........ . . . ................. . . ..... . .... . ............................. . . . . . .................. . . ......... . . .. .........................