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Home My WebLink AboutChange Order No 1 & PCA - Erskine Well No. 2 Rehabilitation Proj No. 119-096 - Peerless Midwest, Inc.1316 COUNTY —CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARDU LIC WORKS March 10, 2020 Mr. Frank Williams Peerless Midwest, Inc. 55860 Russell Industrial Pkwy, Mishawaka, IN 46545 RE: Change Order No. 1 (Final)/Project Completion Affidavit Erskine Well No. 2 Rehabilitation — Project No. 119-096 Dear Mr. Williams: PHONE 574/235-9251 FAX 574/235-9171 The Board of Public Works, at its meeting held on March 10, 2020, approved the Final Change Order for this project, for a decrease of $2,600. The new Contract sum is $62,000. In addition, the Project Completion Affidavit for this project was approved in the amount of $62,000. 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 ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR CITY OF SOUTH BEND DEPARTMENT OF PUBLIC WORKS PROJECT CHANGE ORDER DATE: 02/11 /2020 PROJECT NO: 119-096 PROJECT NAME: Erskine#2_µ.................Rehabilitation ... ........ ell CONTRACT DATE: 11/26/2019ITITIT mmmmIT mITITIT CHANGE ORDER NO. 1 ............... SUBJECT OF CHANGE ORDER: See attached memo for summalloI dram es. See attached Comparison of Estimate for overruns and underruns. w .... ....... _. __. .. ....... The original contract sum $ 64,600 Net change by previously authorized change orders $ ..w0 �._ ..... The contract sum prior to this change order $ 64,600 By this Change Order, the project amount is Increased 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 Decreased $ 2,600 6..__._.. $ ww _. 2,000 (4) % 4 April 8, 2020 0 0 A ri18 20�W ___.. .. .... RECOMMENDED FOR APPROVAL. t CON C.TJON MANAGER CIT OF SOUTH BEND BOARD OF PUBLIC WORKS Approved Date;' an Gary A Giloi, President ll�rabetla Aarad�.k,„µMember "1"here o J, Dora � Mernelf� tor( V. Gathers, Member 'e"w -eph R. Molnar, Zem-ni, CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Erskine Well #2 Rehabilitation PROJECT NO ] 19.096 FINAL COST $62,000.00 CONTRACT SIGNED 11/211g MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Clea..njn:,, lr ct on, a. d rehabilitation toy° Well 2 at Erskine Well Field. WIT 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 18th day of dry�, 20120 Signature James R. William Printed Name Peerless -Midwest Inc. Company Name 55860 Russell Industrial Pkwy Company Address Mishawaka IN 46545 City, State, Zip WITNESSESS: Before me,the undersigned Notary Public in and for said country and state, personally appeared James R . Wi 1 l i am and acknowledged his/her signature to the above Project Complefion Affidavit on the, 18t „ 2 0 WdayFebruary CATHY S. LANCE rc � Notary Public, State of Iraqi Notary Signaturea y My Commission r6°'ANP $1, Joseph Goons; f C t L n S %�� My Commission t y,pi; ' � l; " a 06, 2023 °r1 vey Jun Printed Name County of Reside If the Contractor is a corporation, the following certificate will be executed. Michael J Williams I . certify that I am Secretary of the Corporation executing this release; that James R. Wi 11 i ams 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 A fl rit p y of its governing body, and is within the scope of corporate powers: ti Secretary's Signature Corporate Seal Michael J. Williams Printed Name % DEPARTMENT OF PUBLIC WORKS APPROVAL This project is oce table or a ro we val and recommend to the Board of Public Works that it be ordained so. P 1 PP Date: Z • Z • Z.C± Constructio agar m� GaryM A. adotl�' resider i AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of S t . —Joseph SS: attge W being duly sworn that he/she is the General Mana er (Name of Officer) (Title) of Peerless -Midwest Inc. mITITIT having contracted with C t of South Bend (Subcontractor/Supplier) (Contractor) to famish certain materials and/or labor as follows: Well C l (Description) for a project known as e . (Name of Project) _. located at and owned by City of South Bend De artment of PublicPqblic lonk s (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 Sixty -Two Thousadn Dollars & No Cents. C?�pQQ ❑ receipt of which is hereby acknowledged; or ID 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, famished 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 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 office° 4seall,0yahe th day of Februar 200 2QACATHY S. LANCE Not nS.t�t�yg Notary Public state of Indiana •�ncra�r My Commission Expires"' St. Joseph county ,p�� Cathy S. Lance '*�xJt$ 0 Indiana Residing in Notary Public Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 02/25/2020 v Name To Villa _................... Department En ineerinng ........... ..................�_......._....... BPW Date 3/10/2020 Phone Extension 5920 Required Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney F-] Attorney Name Purchasing Check the Appropriate Item 1`yp ........................ ❑ Professional Services Agreement ❑ Contract F-1 Open Market Contract E] Amendment/Addendum F] Bid Opening f-1 Bid Award EJ Quote Opening El Quote Award ❑ Proposal Opening ❑ C/O & PCA No. 1(final) ❑ 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[Descri tat ( ui `ed Information All Submissions LJ Proposal El Special Purchase, QPA El Req. to Advertise Reject Bids/Quotes PCA Resolution Ease./Encroach Peerless Midwest [� Yes ❑ If Yes, Approved by Purchasing No MBE ❑ iv-DrCompleted E-Verify Form Attached Erskine Well #2 Rehabilitation 119-096 Water Works — Source of Sy2p 620.0640.602.31.06 .............................. ect Closeout For Chan e.Orders 0i 1 ❑ Title Sheet ❑ Yes ❑ No and Other Professional Services Amount of ❑ Increase $IT .. ..._............ ...... ® Decrease $2,600.00 ............. Previous Amount $ 64,000.00 Increase % ...... __........... Current Percent of Change: Decrease (4.00%) New Amount $ 62,000.00 _._._......._... ._- . ................... ._u �........_._ Increase % Total Percent of Change: Decrease (4.00%) Time Extension Amount: .................................................. ................. .. New Completion Date: