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HomeMy WebLinkAboutChange Order No 1 & PCA - Edison Well #3A Rehabiliation Proj No. 119-097 - Peerless Midwest, Inc.1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS April 28, 2020 Mr. Frank Williams Peerless Midwest, Inc. 55860 Russell Industrial Pkwy. Mishawaka, IN 46545 RE: Change Order No. 1 (Final)/Project Completion Affidavit Edison Well No. 3A Rehabilitation — Project No. 119-097 Dear Mr. Williams: PHONE 574/235-9251 FAx 574/ 235-9171 The Board of Public Works, at its meeting held on April 28, 2020, approved the Final Change Order for this project, for a decrease of $4,550. The new Contract sum is $62,350. In addition, the Project Completion Affidavit for this project was approved in the amount of $62,350. 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, s/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: PROJECT NO: PROJECT NAME: CONTRACT DATE: CHANGE ORDER NO. SUBJECT OF CHANGE ORDER: 04/17/2020 119-097 Edison Well #3A Rehabilitation 11 /26/2019 1 See attached memo for summary of changes. See attached Comparison of Estimate for overruns and underruns. The original contract sum Net change by previously authorized change orders The contract sure prior to this change order By this Change Order, the project amount is ❑ Increased ® Decreased 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 1,67 Ikh('V I� i $ 66,900 $ 0 $ 66,900 $ 4,550 $ 62,350 (7.3) % 7.3 % April 8, 2020 0 0 Apri18, 2020 RECOMMENDED FOR APPROVAL 161, CONST TION MANAGER CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Approved Date: _—April 28, 2020 BOARD OF PUBLIC W ORK5 � G%5xy�t-rat Gary A. Gilot, President Elizabeth A. Maradik, Member Therese J. Dorau. Member .Jordan V. Gathers Member Joseph R. Molnar, Member ATTEST: cifz `'c Gffi71& Linda M. Martin, Cleik CITY OF SOUTH SEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT ? . PROJECT NAME Edison Well #3A Rehabilitation PROJECT NO 119-097 FINAL COST $62,350,00 CONTRACT SIGNED 11/2612019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Cleaning, inspection, and rehabilitation for Well 3A at Edison Well Field. WITN ESSETI-i: The work under the above contract between the City of South Bend and the undersigned contractor having boon completed', the City of South Mond, 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 21st day of April 20120 Peerless -Midwest, Inc. Company Name 5 gnature 55860 Russell Industrial Parkway. James R. Williams 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 James R. Williams , and acknowledged his/her signature to the above Project Completion Affidavit on the 1st of, April //:'1201 20 G... pjr r✓ � ,.. M 1 abM�g�Pit r°j"" ATHY S, tANCfc Notary SignaturelfMy Commission Expires Cathy S. Lance %Im �� sr_. JasPph cowlty °e ti 1 omMnission Ex�irrss Printed Name County of Residence I. °� ,; epl7 -111no n, 202 If the Contractor is a corporation, the following certificate will be executed. I, Michael 1. Williams _ certify that I am Secretary of the Corporation executing this release; that James R. 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 Authority of its governing body, and is within the scope of corporate powers: ��d� Secretary" iegnature Corporate Seal Michael J. Williams Printed Name - DEPARTMENT OF PUBLIC WORKS APPROVAL. This project Is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. _ Date: 04/21 /2020 Cnnstru on Manager BOARD OF PUBLIC WORKS APPROVAL bate. April 28, 2020 13C71XI2.D OF PL731LIC W C)I2ICS Gary A. Gilot, President Elizabeth A_ Maradik- Member Therese J. Dorau, Merriber Jordan V. Gathers, Member ATTEST: �IiZ.�CF C` �iR77712 Joseph K. Molnar, Member Linda M. Martin, Clerk CITY OF SOUTH BEND PURCHASE ORDER 256089 �,. Accounts Payable -12 Floor County/City Building ,. 227 W. Jefferson Blvd. , South Bend, IN 46601 — Fax (574) 235-9928 THE ABOVE ORDER NUMBER - The City of South Bend is an Equal Opportunity Employer MUST APPEAR ON ALL INVOICES, j CLAIMS, PACKAGES, DELIVERY SLIPS, AND CORRESPONDENCE TO: PEERLESS MIDWEST INC SHIP TO: WATER WORKS - NO. STATION PO BOX 207362 WATER WORKS NORTH STATION DALLAS, TX 75320-7362 830 N. MICHIGAN ST. SOUTH BEND, IN 46601 ISITION # 0000224468 NOTICE TO VENDOR 'ER BY DATE 12/06/2019 1. If Vendor delivers any merchandise without valid purchase order, no liability exists for City of South Bend 2. City of South Bend reserves right to cancel all or part of this order if delivery is not made when and as COUNT NO 62006406023106 Ispecified. NDOR'S NO 65605 3. Vendor accepts this order at listed price or lowest prevailing market price. No price increase allowed after PROJECT NO 4. All goods subject to inspection and rejection (freight at vendor's expense), not withstanding prior payments to secure cash discount.. 5 If subject to cash discount, please indicate on invoice or claim. REQUISITION DATE 12/06/2019 FEDERAL EXCISE TAX EXEMPTION INDIANA SALES TAX EXEMPTION 35-6001201 0003502538-001 ITEM # QUANTITY/UNIT ITEMS and DESCRIPTION Price Total 1 EDISON WELL #3A REHABILITATION 66, 900.00 / EA This order issued in compliance with Chapter 99, Acts 1945 and acts amendatory thereof and supplemental thereto. I hereby certify there is an unobligated balance in this appropriation sufficient to pay for this order. � r Controller or Authorized Representative 1.0000 66, 900. 00 Egkls6 o;pp�olln1m ty^ EMPn Gy�n f4e . kLp APPROVED — Central Purchasing Office PO. Number 256089 AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of St. Joseph SS: James R. Williams _ being duly sworn that helsbe is the _ eneral Manager (Name of Officer) (Title) of Peerless -Midwest, Inc. having contracted with City of South Bend Board of Public Works (SubcontractorlSupplier) (Contractor) to furnish certain materials and/or labor as follows: Labor & Materials for Edison Well 3A Rehabilitation (Description) for a project known as Project No. 119-097 Edison Well 3A (Natne of Project) located at Edison Well 3A and owned by City of South Bend De artrnent of Public Works (Owner) and does hereby further stata on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sung of Dollars ($ ❑ receipt of which is hereby acknowledged, or ❑ the payment ofwhlch has been promised as the sole consideration for Ibis Affidavit and Final. WMver of Lion wlkh. is given solely with respect to said amount, and which waiver shall be. effeective onlyup6n w alpt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Sixty -Two Thotu5and Three Hundred Fifty Dollars _ ($ 62,350.00) ❑ 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 an the aboye desod0ed,prgporty acid improvements thereon #A ac oW ofiabor or material or bothfpMisliod b the alders# 00 thereto, subjaot to Jitrtitatiaifs or cont(ltions .t*xpressed, herein; if any; aiid furlhsr certifies! the# no, other; party bag ogy c1&itit mright to a Nit on account_o f any Wpo k perfQrtned .ar M terld flihiish©d tb'the undersigned for said project, Arid Wt# is pe of tlils f iflavit $tid Waiver of Lien, // Peerless -Midwest Inc. (Finn) (Aitthnrixed Representative) STATE OF INDIANA } SS: ST. JOSEPH COUNTY ) Before tne, the undersigned, a Notary Public, in and for said County and State, personally appeared dames R. Williams and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, t have hereunto subscribed my name and affixed my of ci l seal he , z 1% day of April 200 20 CAlHY S. I ANCENotary Public gnature F'7 " , Notary Public, State nS Indiana MyComnmissionExpires: 06,012fl u`°:, 5t. Joseph County Ft�nty` \t 4Tn.�vly Commission uxpirqr; Cathy S. Lance Notary Pdblic _ �t^;• -�. Residing in Indiana Crj ;��; 4�. err ne O6 2023 r� BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 04/21/2020 Name Toy Villa Department Engineering BPW Date 04/28/2020 Phone Extension 5920 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Re uired or All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ® C/O & PCA No. 1 final ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution ❑ Other: ❑ Ease./Encroach Required Information Company or Vendor Name Peerless Midwest, Inc. ❑ Yes ❑ If Yes, Approved by Purchasing New Vendor ❑ No MBE Yes MBE/WBE Contractor Completed E-Verify Form Attached ❑ ❑ No Project Name Edison Well 43A Rehabilitation Project Number 119-097 Funding Source Water Works — Source of Supply and Other Professional Services Account No. 620.0640.602.31.06 Amount Terms of Contract Purpose/Description Proj ect Closeout For Change Orders Only Amount of ❑ Increase $ ® Decrease ($ 4,550.00) Previous Amount $ 66,900.00 Increase Current Percent of Change: Decrease New Amount $ 62,350.00 Increase Total Percent of Change: Decrease Time Extension Amount: New Combletion Date: 7.30% 7.30%)