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Home My WebLink AboutChange Order Nos 2 & 3 - Corby Ironwood Rockne Intersection Improvement Proj No. 116-034 - Rieth Riley Construction Co., 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 October 27, 2020 Mr. Joshua McCormick Rieth-Riley Construction Co., Inc. 25200 State Road 23 South Bend, IN 46614 j mcc ormickgrieth-riley. com PHoNE 574/235-9251 FAx 574/235-9171 RE: Change Order Nos. 2 & 3 — Corby, Ironwood, Rockne Intersection Improvements Project No. 116-034 Dear Mr. McCormick: The Board of Public Works, at its meeting held on October 27, 2020, approved the Change Order No. 2 for an increase of $20,976.50, bringing that current contract amount to $3,156,705.50. The Board of Public Works also approved the Change Order No. 3 for an increase of $5,956.20, bringing the current contract total amount to $3,162,661.70. Enclosed is a copy of the Change Orders 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 Enclosure GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR CITY OF SOUTH BEND DEPARTMENT OF PUBLIC WORKS DIVISION OF ENGINEERING TO: Board of Public Works FROM: Leslie Biek, PE SUBJECT: Corby Ironwood and Rockne Change Orders 4 & 5 DATE: 10/15/2020 Attached you will find two change orders for the federally funded Corby Ironwood and Rockne Intersection Improvement project (PN 116-034). Change order #2 is for the relocation of three (3) water meter vaults, water valves and the addition of a 2" water service for a total price of $20,976.50. Change order #3 is for the addition of ten (10) arborvitae around the newly created retention pond for an additional price of $5,956.20. Both changes orders 2 and 3 are not federally participating and as a result will be 100% locally funded. It is requested the Board of Public Works approve Change Orders 2 and 3 for the Corby, Ironwood and Rockne project (PN 116-034) for an increase of $26,932.70 bringing the new contract price to $3,162,661.70. Thank you for your consideration of this request. Contract No:R -39540 Change Order No.: 002 INDIANA Department of Transportation Page: 1 Construction Change Order and Time Extension Summary Contract Information Contract No.: R -39540 Letting Date:03/04/2020 Di strict:LAPORTE DISTRICT AE:Patterson, Patrick PE/S:Wills, Dale Status:Pending Change Order Information Change Order No.: 002 EWA: Y or Force Acct: N Date Generated: 07/23/2020 Date Approved: 00/00/0000 Reason Code: ERRORS & OMISSIONS, Design/Plan Related Description: Water Meter/Valve Relocations Original Contract Amount $ 3,135,729.00 Current Change Order Amount $ 20,976.50 Percent: 0.669 % Total Previous Approved Changes $ 0.00 Percent: 0.000 % Total Change To -Date $ 20,976.50 Percent: 0.669 % Modified Contract Amount $ 3,156,705.50 Time Extension Information Date Initiated 00/00/0000 Date Completed 00/00/0000 Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0 SP Date 00/00/0000 or SP Days (SS = Standard Specification, SP = Special Provision) Time Element Description: Current Time Extension Previous Time Approved Revised Contract Time SSDays OSPDays 0 SS Days by AE: DCE SS Days SP Days Value $ 0.00 SCE: DDCM: SP Days Value $ SS Completion Date 00/00/0000 or SS Calendar/Work Days 0 SS Date 00/00/0000 or SP Days 0 Contract No:R -39540 INDIANA Department of Transportation Construction Change Order and Time Extension Summary Review and Approval Information Required Approval Authority ($ per Change Order) (Days per Contract) Verbal Approval Required? Total Change To-Date>5%? Scope/Design Recommendation Required? Change Order No.: 002 Page: 2 AE: DCE: SCE: * DDCM: (-LE$250K-) (-LE$750K-) (--LE$2M--) (--GT$2M--) ( 50 SS days) ( 100 SS days) ( 200 SS Days) ( GT 200 SS days) Y / N If Y, by Date Issued Y / N If Y, Copy to Program Budget Manager Y / N If Y, Referred to Project Manager(PM) Date to PM Approval Authority Concurs with PM? Y / N If Y, Concurrence by If N,Resolution: Approved LPA Signatures Required? FHWA Signatures Required? Resolved by Y / N If Y, Date to LPA Y / N If Y, Date to FHWA Date Returned Date Disapproved Date * Field Engineer Recommendation (Required for SCE or DDCM Approval) Field Engineer Date Comments: Date Returned Date Returned Contractor: Rieth-Riley Date:10/14/2020 Contract No:R -39540 INDIANA Change Order No:002 Department of Transportation Contract: R -39540 Project: 1600074 - State:160007400LC4 Change Order Nbr: 002 Change Order Description: Water Meter/Valve Relocations Reason Code: ERRORS & OMISSIONS, Design/Plan Related CLN PCN PLN Item Code Unit Unit Price CO Qty Comment 0148 1600074 0148 105-06807 LS 20,976.500 1.000 C Item Description: ADDITIONAL Supplemental Descriptionl : City of South Bend water meter structures and water services Supplemental Description2: Date:10/12/2020 Page: 3 Amount Change Amount:$ 20,976.50 Total Value for Change Order 002 = $ 20,976.50 Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended. General or Standard Change Order Explanation Three City of South Bend water meter vaults for sprinkler systems at 808, 811 and 820 Ironwood Drive needed to be moved out of the new widened roadway. Also three house City of South Bend service water shutoffs at 808, 811 and 822 Ironwood Drive needed to be moved behind the new curb for the widened roadway. Also a 2" water service to the church at 915 Ironwood Dr. needed to be lowered for the new storm sewer. Price includes hauling off abandoned water meter vaults that were removed from beneath new roadway location. Change Order Explanation for Specific Line Item It is the intent of the parties that this change order is full and complete compensation for the work describe above. Notification and consent to this change order is hereby acknowledged. Digitally signed by Jamie Plunkett Jamie Plunkett ON: C=US, E=Cp tr cti ey -So O=RIeCN_d y i. Pi UGtlon Co..Ga., OU-South Bend, CN=damie Plunkett Signed By: oate:2020.10.14 09:28:28-04'00• NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system. Contract No:R -39540 INDIANA Change Order No-002 Department of Transportation APPROVED FOR LOCAL PUBLIC AGENCY BOARD OF PUBLIC WORKS Gary A. Gilot, Presidoni n—. J. Do Member W Eli.Mh A. Maradik, Member Jordan V. Gathers, Member rYZ ATTEST: h'inAa cffmnn JoseOh R. Molnar, Member kr.a•a....+..+....:.+a:+..>.a:a..+.r++s.+•.+.+a..••..+...•...+ftf+s Linda M. Marti., Clerk 1 SUBMITTED FOR CONSIDERATION PE/S fY c Date:10/12/2020 Page: 4 October 27, 2020 (DATE) APPROVED FOR INDIANA DEPARTMENT OF TRANSPORTATION Approval Level Name of Approver Date Status Project Engineer/Supervisor Patterson, Patrick 00/00/0000 Action Pending IETH `KILEY CONSTRUCTION CO., INc. 100% Quality • 100% Employee Owned • Over 100 Years June 17, 2020 Mr. Dale Wills Lochmueller Group 112 W Jefferson Blvd Suite 500, South Bend, IN 46601 RE: R-39540-A, Water Service Relocates Dear Mr. Wills As discussed, the following are the prices for the water service curb stop and meter pit relocations for those in conflict on the project. Also described is the 2" relocation. The unit measure is on a "per each'. • Relocate 2" water service to the church o $4,280.00 o +7% $299.60 Unit Price $4,579.60 1 location Extension $4,579.60 • Relocate Curb Stop o $2,420.00 o +7% $169.40 Unit Price $2,599.40 3 locations Extension $7,768.20 • Relocate Meter Pit o $2,470.00 o +7% $172.90 Unit Price $2,642.90 3 locations Extension $7,928.70 • Load up and haul off all existing concrete structures o $700.00 Lump Sum Extension $700.00 Total value for all items = $20,976.50 Please let us know if you would like to proceed with this work. Thank you. Respectfully Sub Jamie Plunkett Rieth Riley Construction Company 25200 S.R. 23 • South Bend, IN 46614 Phone: (574) 288-8321 • www.rieth-riley.com CHANGE ORDER REQUEST FORM CONTRACT R-39540 DATE OF June 17, NO. SUBMISSION 2020 PROJECT DESCRIPTION IRONWOOD ROAD AND CORBY BLVD (route / intersection / bridge no(s).) CHANGE ORDER REQUEST SUMMARY Water service relocates J DESCRIPTION PROPOSED SOLUTION SUMMARY Relocate services due to conflicts NOTE: Upon request from Engineer, enter detailed description on page 2. ONSET DATE OF CHANGE June 17, 2020 CHANGE ORDER TYPE 104.03 Extra Work PROPOSED COST AND TIME ADJUSTMENT COST INCREASE / 20,976.50 COST(DECREASE): $........................................................................................................ The cost adjustment shall include lump sum and estimated totaled unit -priced item costs. Attach a separate sheet of unit price items including item description, unit of measurement, estimated quantity and unit price. CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF COST CHANGE: ❑ 109.03 Altered Quantities ® 109.05(a) Agreed Price ❑ 109.05(b) Force Account ❑ 109.05.02 Delay Costs PROPOSED COST CHANGE INCLUDES: ❑ Labor ❑ Material ❑ Equipment ❑ Lease Agreement Subcontractor TIME ADJUSTMENT INCREASE / (DECREASE): CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: (work days) N/A ❑ 108.08(a) Excusable, Non-Compensable ® 108.08(b) Excusable, Compensable NOTE: If Compensable, attach details based on 109.05.2(a) Allowable Delay Costs. SUPPLEMENTAL INFORMATION Additional information may be entered by the contractor. CHANGE ORDER ORIGINATION_ IK INDOT/ LPA 401610I 40luu. ;l9ft ag ❑ Contract Specifications (ref. doc name/no.) ❑ Contract Plans (ref. doc name/no.) CHANGE ORDER AFFECTS DBE PARTICIPATION: Click here to enter text. Click here to enter text_ ❑ yes ® no (if yes, attach details) ❑ Contractor Ver. 10.23.17 CHANGE ORDER REQUEST FORM CONTRACT NO. R-39540 UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF ADDITIONAL DETAIL [Select Date] ADDITIONAL DETAIL (Select Date] DETAILED DESCRIPTION / JUSTIFICATION: (include location(s), actions of contractor, owner, and other stakeholders, key events and related couse(s), discoveries, discussions, meetings, and effect on the contract if no action is taken. Also include references to key documents attached or available to support this change order request.) Click here to enter text. I PROPOSED SOLUTION — ADDITIONAL DETAILS: (include proposed scope of work, means & methods, materials, equipment, utility relocation required, subcontracted scope and the effect on the contract schedule. Also include references to attached documents including, but not limited to, sketches, calculations, photos, material information, and submittals and meeting minutes.) Click here to enter text. SIGNATURES Contractor: Name: (print) (signature) Date: Project Engineer/Supervisor: (signature is to acknowledge receipt of the document and does not signify agreement of the change order) Name: (print) (signature) Date: NOTE: The Contractor and PENS should retain a signed copy of this document for record. P9 '' CHANGE ORDER REQUEST FORM CONTRACT NO. R-39540 ATTACHMENT: UNIT PRICE ITEMS DETAIL Attach or paste a unit price item detail. pg. 3 Jamie Plunkett From: John Kramer <johnk@hrpconstruction.com> Sent: Wednesday, June 17, 2020 2:34 PM To: Jamie Plunkett Cc: Jered Baker Subject: Water Service Relocation Work on Corby & Ironwood F ION: Th notclick lii Please see below for the requested pricing. Additional Price for 1 - 1" water service relocation - $2 420 Includes Excludes • HRP Labor and equipment • +/- 15 ft 1" Type K copper • 2 - 1" couplings • Utilizing the existing corporation stop and service line • Installing the curb stop withing 2' of the new curb • Reconnecting the service within public ROW • Going onto private property • Restoration • Re -tapping of main • Waiting on the City Water Dept to do any work. Additional Price for 1 - 1" Meter Pit - $2,470 Includes Excludes • HRP Labor and equipment • 48" MH with Casting • 2 - 1" Brass Ball Valves • Going onto private property • Restoration • New Water Meter and Meter Yoke • Haul off of existing concrete structures. • Waiting on the City Water Dept to do any work. If HRP would relocate the existing water service and add a meter pit the total price would be $4,890 Additional Price for 2" Water Service Relocation - $4 280 i Includes Excludes • HRP Labor and Equipment • 2" Copper, 2" Couplings, and 2" 90 degree bends • Warranty on Water service work • Curb Box and Curb Stop • Replacing the existing valve vault. Let me know if you have any questions, John Kramer John Kramer Estimator / Project Manager HRP Construction (574)271-7800 - Office (574)383-0653 - Mobile (574)271-0524 - Fax www.hroconstruction.com HRP CONSTRUCTION i This e-mail and any attachments thereto, are intended only for use by the addressee(s) named herein and may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying of this e-mail, and any attachment thereto, is strictly prohibited. If you have received this e- mail in error, please respond to the individual sending the message, and permanently delete the original and any copy of any e-mail and printout thereof. SECTION 5 - WATER WORKS street Sidewalk Light Duty Cast Iron Frame and Cover (See Note 3) 4" Curb Stop Valve and Box Core Holes for Piping (Typ•) (See Note 2) Direction of Flow /1 Type "K" Copper Pipe Link seal (Typ.) or J Approved Equal Curb Stop Valve and Box Direction of Flow L 24" Min. ne - Grade a ° �n ° G Precast Conc. 4'-0" 4" (Square or Circular) 10" Clearance (Typ.) 1", 1', or 2" c Meter ° Inlet Ball Outlet Ball ° Valve Valve ° c � f Precast Conc. Base o 4 ° Min. — Inlet Ball Valve Outlet Ball Valve 0 0 0 1", 1 Y, or 2" Meter G ° PLAN VIEW NOTES: 1. Precast Conc. structure shall be manufactured and installed in compliance with ASTM C-478 (round str.) or ASTM C-913 (rectangular/square str.) 2. The cored opening shall be large enough to allow passage of the pipe flange. 3. Lid shall have the word "WATER" cast into it. If placed in a paved area, casting shall be heavy duty. f Bok STER<<o FS' N0. = • - PE10809510 = • )3---, STATE OF - Qj IVQ %SS/ONAL ///JJlllllllt0�\ Aaj. il F-k' /�`," IPA- ---, 6/26/18 REF STD SPEC SEC Kara M. Boyl , Ph.D.;; P.E. Date APPROVED/REVISED BY THE BOARD OF PUBLIC WORKS EFFECTIVE DATE: June 26, 2018 CITY OF SOUTH BEND Item Revision Approved Date STANDARDS FOR DESIGN AND CONSTRUCTION STANDARD METER PIT SPECS. FOR 1", 1 1/2", AND 2" METERS 1 5-13 Contract No:R -39540 Change Order No.: 003 INDIANA Department of Transportation Page: 1 Construction Change Order and Time Extension Summary Contract Information Contract No.: R -39540 Letting Date:03/04/2020 District:LAPORTE DISTRICT AE:Patterson, Patrick PE/S:Wills, Dale Status:Pending Change Order Information Change Order No.: 003 EWA: Y or Force Acct: N Date Generated: 00/00/0000 Date Approved: 00/00/0000 Reason Code: SCOPE CHANGES, Added Quantities/Items Description: Arborvitae Trees by Stormwater Basin Original Contract Amount $ 3,135,729.00 Current Change Order Amount $ 5,956.20 Percent: 0.190 % Total Previous Approved Changes $ 0.00 Percent: 0.000 % Total Change To -Date $ 5,956.20 Percent: 0.190 % Modified Contract Amount $ 3,141,685.20 Time Extension Information Date Initiated 00/00/0000 Date Completed 00/00/0000 Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0 SP Date 00/00/0000 or SP Days (SS = Standard Specification, SP = Special Provision) Time Element Description: Current Time Extension Previous Time Approved Revised Contract Time SS Days 0 SP Days 0 SS Days by AE SS Days SP Days Value $ 0.00 DCE: SCE: DDCM: SP Days Value $ SS Completion Date 00/00/0000 or SS Calendar/Work Days 0 SS Date 00/00/0000 or SP Days 0 Contract No:R -39540 INDIANA Department of Transportation Construction Change Order and Time Extension Summary Review and Approval Information Required Approval Authority ($ per Change Order) (Days per Contract) Verbal Approval Required? Total Change To-Date>5%? Scope/Design Recommendation Required? Change Order No.: 003 Page: 2 AE: DCE: SCE: * DDCM: (-LE$250K-)(-LE$750K-)(--LE$2M--)(--GT$2M--) ( 50 SS days) ( 100 SS days) ( 200 SS Days) ( GT 200 SS days) Y / N If Y, by Date Issued Y / N If Y, Copy to Program Budget Manager Y / N If Y, Referred to Project Manager(PM) Date to PM Approval Authority Concurs with PM? Y / N If Y, Concurrence by If N,Resolution: Approved LPA Signatures Required? Resolved by Y / N If Y, Date to LPA Date Returned Date Disapproved Date Date Returned FHWA Signatures Required? Y / N If Y, Date to FHWA Date Returned * Field Engineer Recommendation (Required for SCE or DDCM Approval) Field Engineer Date Comments: Contract No:R -39540 INDIANA Change Order No:003 Department of Transportation Contract: R -39540 Project: 1600074 - State:160007400LC4 Change Order Nbr: 003 Change Order Description: Arborvitae Trees by Stormwater Basin Reason Code: SCOPE CHANGES, Added Quantities/Items CLN PCN PLN Item Code Unit Unit Price CO Oty Comment 0149 1600074 0149 622-01937 EACH 595.620 10.000 C Item Description: PLANT Supplemental Description-1 - Tree plantings in front of stormwater basin on Corby Blvd. Supplemental Descriptionl: Date:10/15/2020 Page: 3 Amount Change Amount:$ 5,956.20 Total Value for Change Order 003 = $ 5,956.20 Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended. General or Standard Change Order Explanation The City of South Bend added arborvitae trees along the fence line of the stormwater basin on Corby Blvd. Change Order Explanation for Specific Line Item It is the intent of the parties that this change order is full and complete compensation for the work describe above. Notification and consent to this change order is hereby acknowledged. oIpwry signed by Ja- PI-1 ❑- -th-R E=jplunMatl@na�h-Al OU=S Jamie P l u n kett �.+h-R''ujn" "" �. a=5 he� Rieth—Rile Construction Co.CN�eRun Contractor: Y Signed By: Date: 2pgg.,o15M,3:56�400• 10/15/2020 NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system. Contract No:R -39540 INDIANA Change Order No:003 Department of Transportation x+rx+rr++rx+rrrxxr:rrr+r++rr+x+xr:+rrr:+rrrrr+rrrrrrrrrrrr+r++r+rtrrrrrrxxxrrrrxrxrrxrr+rrrrrr+r+rrrrrrr+++rrrrrrrr:rrrrrr:+ 130ARD GP PUBLIC WORKS APPROVED FOR LOCAL PUBLIC AGENCY Q'&-CA� 1 0 Gary A. GiM, President Therese J. Doraq Member Elizabeth A. Maradik, Member Jordan V. Gathers, Membe ATTEST: ri�rAa rix Joseph A Molar, Member Linda M. Marti., Clerk#r++f+i+rr+irira+rrr++txr+rr#rrr+rirrtt+r#++tat at++ttttt#+######t# rSUBMITTED FOR CONSIDERATION PE/S r Date:10/15/2020 Page: 4 October 27, 2020 (DATE) APPROVED FOR INDIANA DEPARTMENT OF TRANSPORTATION Approval Level Name of Approver Date Status Project Engineer./Supervisor Patterson, Patrick 00/00/0000 Action Pending July 15, 2020 Mr. Dale Wills Lochmueller Group 112 W Jefferson Blvd Suite S00, South Bend, IN 46601 RE: R-39540-A, Arborvitae Dear Mr. Wills Please find the following cost per tree for a total of 10 EA Arborvitae trees. The largest trees Slussers could find are 6'/8' in height. It is possible that in the fall there could be 8'/10' in height available. The unit price for supplying and planting will be. 10 EA @ $595.62 Extension $5,956.20 Please contact me with any questions you might have. Let me know if you have question. I have attached back up documents to this letter. Consider this as our formal request to add this work to the contract. Thank you for your consideration on this topic. Respectfully Submitted, Jamie Plunkett Project Manager Rieth Riley Construction Company CHANGE ORDER REQUEST FORM CONTRACT R-39540 NO. DATE OF July 15, SUBMISSION 2020 PROJECT DESCRIPTION IRONWOOD ROAD AND CORBY BLVD (route / intersection / bridge no(s).) CHANGE ORDER REQUEST SUMMARY THE CITY REQUESTED THAT TREES BE PLANTED FOR A BARRIER DESCRIPTION TO THE DRY RETENTION BASIN. PROPOSED SOLUTION SUMMARY PLAN 10 EA ARBORVITAE TREE AT 6' TO 8' TALL NOTE: Upon request from Engineer, enter detailed description on page 2. [ONSET DATE OF CHANGE July 15, 2020 CHANGE ORDER TYPE -- 104.03 Extra Work PROPOSED COST AND TIME ADJUSTMENT COST INCREASE / 5,956.21 COST(DECREASE): $.......................................................................................................... The cost adjustment shall include lump sum and estimated totaled unit -priced item costs. Attach a separate sheet of unit price items including item description, unit of measurement, estimated quantity and unit price. CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF COST CHANGE: ❑ 109.03 Altered Quantities ® 109.05(a) Agreed Price ❑ 109.05(b) Force Account ❑ 109.05.02 Delay Costs PROPOSED COST CHANGE INCLUDES: ❑ Labor ❑ Material ❑ Equipment ❑ Lease Agreement Z Subcontractor TIME ADJUSTMENT INCREASE / (DECREASE): CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: (work days) N/A ^J ❑ 108.08(a) Excusable, Non-Compensable ❑ 108.08(b) Excusable, Compensable NOTE: If Compensoble, attach details based on 109.05.2(a) Allowable Delay Costs. SUPPLEMENTAL INFORMATION Additional information maybe entered by the contractor. CHANGE ORDER ORIGINATION: DOCUMENTS AFFECTED: ❑ Contract Specifications (ref. doc name/no.) ❑ Contract Plans (ref. doc name/no.) CHANGE ORDER AFFECTS DBE PARTICIPATION: ® INDOT/ LPA Click here to enter text. Click here to enter text. ❑ yes ® no (if yes, attach details) 0 Contractor Ver. 10.23.17 CHANGE ORDER REQUEST FORM CONTRACT NO. R-39540 UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL F-- — DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF i ADDITIONAL DETAIL [Select Date] ADDITIONAL DETAIL [Select Date] DETAILED DESCRIPTION / JUSTIFICATION: (Include location(s), actions of contractor, owner, and other stakeholders, key events and related couse(s), discoveries, discussions, meetings, and effect on the contract if no action is taken. Also include references to key documents attached or available to support this change order request.) Click here to enter text. PROPOSED SOLUTION — ADDITIONAL DETAILS: (Include proposed scope of work, means & methods, materials, equipment, utility relocation required, subcontracted scope and the effect on the contract schedule. Also include references to attached documents including, but not limited to, sketches, calculations, photos, material information, and submittals and meeting minutes.) Click here to enter text. SIGNATURES Contractor: Name: (print) (signature) Date: Project Engineer/Supervisor: (signature is to acknowledge receipt of the document and does not signify agreement of the change order) Name: (print) (signature) Date: NOTE: The Contractor and PE/s should retain a signed copy of this document for record. pg. 2 CHANGE ORDER REQUEST FORM CONTRACT NO. R-39540 ATTACHMENT: UNIT PRICE ITEMS DETAIL Attach or paste a unit price item detail. pg. 3 RIETH-RILEY CONSTRUCTION EXTRA WORK AGREEMENT DATE: 7115/20 WORK PERFORMED: Arbirvitae Markup CONTRACT: R-39540 PROJECT: R39540 Ironwood & Corby FORCE ACCOUNTIEXTRA WORK FOR: LABOR 109.05 (b)(1) HOURS EMPLOYEE Regular Overtime Doubletime TOTAL RATE EXTENSION ENGINEER 0.00 $35.00 $0.00 FINISHER, CRAFT FOREMAN ELKHART)ST JOE 0.00 $35.15 $0.00 FNISHER, CRAFT FOREMAN LAPORTE 0.00 S36.59 $0.00 FINISHER, JOURNEYMAN ELKHART/ST JOE 0.00 S32.90 $0.00 FINISHER, JOURNEYMAN LAPORTE 0.00 $33.59 $0.00 FOREMAN, LABORER,ELKHART/ ST. JOSEPH 0.00 S43.20 $0.00 FOREMAN. ESOP 0.00 S44.20 $0.00 FOREMAN, FINISHER, ELKHART / ST. JOSEPH 0.00 $35.15 $0.00 FOREMAN, FINISHER, LAPORTE 0.00 $36.59 $0.00 FOREMAN, LABORER, LAPORTE 0.00 $43.20 $0.00 LABORER, ELKHART/ ST. JOSEPH 0.00 $26.10 $0.00 LABORER, LAPORTE 0.00 S31.91 $0.00 MECHANIC 0.00 S42.20 $0.00 OPERATOR,ELKHART 0.00 $31A5 $0.00 OPERATOR, LAPORTE) ST. JOSEPH 0.00 $42.201 $0.00 QA TECH 0.00 $26.10 $0.00 PROJECT SUPERINTENDENT 0.00 550.00 $0.00 TEAMSTER 0.00 S30.91 1 $0.00 FRINGES TOTAL LABOR $0.00 (2) FICA 7.50 n x LINE (2) $0.00 (3) EMPLOYEE HOURS RATE EXTENSION ENGINEER 0.00 X $12.79 - $0.00 FINISHER, CRAFT FOREMAN ELKHART/ST JOE 0.00 X $15.60 = $0.00 FINISHER, CRAFT FOREMAN LAPORTE 0.00 x $23.14 = $0.00 FINISHER, JOURNEYMAN ELKHART/ST JOE 0.00 X $15.60 - $0.00 FINISHER, JOURNEYMAN LAPORTE 0.00 X $23.14 = $0.00 FOREMAN, LABORER, ELKHART/ ST. JOSEPH 0.00 X $36.10 = $0.00 FOREMAN, ESOP 0.00 X $36.10 = $0.00 FOREMAN, FINISHER, ELKHART/ ST. JOSEPH 0.00 X $15.60 = $0.00 FOREMAN, FINISHER, LAPORTE 0.00 X $23.14 = $0.00 FOREMAN. LABORER LAPORTE 0.00 X $36.10 = $0.00 LABORER, ELKHART/ ST. JOSEPH 0.00 X $16.38 = $0.00 LABORER, LAPORTE 0.00 x $20.74 = $0.00 MECHANIC 0.00 X $36.10 = $0.00 OPERATOR, ELKHART 0.00 x $30.21 = $0.00 OPERATOR, LAPORTE /ST. JOSEPH 0.00 X $36.10 = $0.00 QATECH 0.00 X $16.38 = $0.00 PROJECT SUPERINTENDENT 0.00 X $12.79 = $0.00 TEAMSTER 0.00 X $16.54 = $0.00 TOTAL FRINGES (4) WORKERS COMPENSATION 5.72 % X LINE (2) $0-00 (5) BODILY INJURY 1 PROPERTY DAMAGE INSURANCE 5.80 % X LINE (2) $0.00 (6) STATE UNEMPLOYMENT 3.85 % X LINE (2) $0.00 (7) FEDERAL UNEMPLOYMENT 0.40 % X LINE (2) $0.00 (8) TRAVEL ALLOWANCE OR SUBSISTENCE (NOTE #3) $0.00 (9) TOTAL LINES 2, 3, 4, 5, 6, 7, 8 8 9 $0.00 (10) 20 %x LINE (10) $0.00 (11) GRAND TOTAL LABOR LINES (10) + (11) $0.00 (12) Page 1 of 2 MATERIAL 109.05 (b)(3) Furcnasecl or Manufactured Description Quantity Unit Unit Price Extenslion $ 5 - S S - $ 5 $ 5 $ $ MATERIALS PURCHASED MATERIALS MANUFACTURED TOTAL: LINE (18)+ (19) 12 % x LINE (20) GRAND TOTAL FOR MATERIALS: LINE (20)+ (21) EQUIPMENT 109.05 (b)(4) SO.00 (18) S0.00 (19) S0.00 (20) S0.00 (21) $0.00 (22) Equipment # CONTRACTOR OWNED EQUIPMENT FHWA HOURLY RATE HOURS EXTENSION S0.00 $0.00 $0.00 $0.00 S0.00 S0.00 $0.00 S0.00 $0.00 S0.00 $0.00 $0.00 $0.00 S0.00 $0.00 S0.00 Trucking - Striaght Time $0.00 $0.00 Trucking -Over Time $0.00 S0.00 Trucking - Double Time $0.00 $0.00 TOTAL EQUIPMENT S0.00 (23) TOTAL TRUCKING S0.00 (24) FUEL, LUBRICANTS AND TRANSPORTATION COSTS S0.00 (25) TOTAL LINES (23) + (24) + (25) SO.00 (26) 12 % x LINE (26) S0.00 (27) GRAND TOTAL FOR EQUIPMENT: LINES (26) + (27) S0.00 (28) SUBCONTRACTORS 109.05 (b)(6) Slussers Plantina Arborvitae TOTAL SUBCONTRACT WEEK ENDING $5,500.00 129) 7 % x LINE (30) OVER $3,000.00 $385.00 (31) (32) GRAND TOTAL FOR SUBCONTRACTORS: LINES (30) + (31) + (32) $5,885.00 (33) TOTAL OF WORK COMPLETED FOR THE WEEK TOTAL LINES (12), (17), (22), (28) 8 (33) �.i % OF BOND RATE BASED UPON LINE (34) $5,885.00 (34) 10 % x LINE (35) $64.74 (35) TOTAL EXTRA WORK LINES: (34) + (35) + (36) S6.47 (36) $5,956.21 (37) Page 2 of 2 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 10/15/2020 Name Leslie Biek Department Engineering BPW Date 10/27/2020 Phone Extension 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 ® Ron O'Connor 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. ❑ PCA ® Chg. Order, No. 2 & 3 ❑ Traffic Control ❑ Resolution n Other: n Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information Rieth R U Yes U If Yes, Approved by Purchasing ® No E] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Corby Ironwood Rockne Intersection Improvement 116-034 LR&S Streets and 442001 $26,932.70 Unit Price This change order is for the relocation of three (3) water meter vaults, water valves and the addition of a 2" water service (CO #2 - $20,976.50) and for the addition of ten (10) arborvitae around the newly created retention pond(CO #3 - $5,956.20). Both of these change orders will not be federally funded. They will be 100% locally funded For Chanize Orders Onl Amount of ® Increase $ 26,932.70 ❑ Decrease ($ ) Previous Amount $ 3,135,729.00 Increase .86% Current Percent of Change: Decrease ( %) New Amount $ 3,162,661.70 Increase .86% Total Percent of Change: Decrease ( %) Time Extension Amount: New Completion Date: