HomeMy WebLinkAboutChange Order No 1 & PCA - 2020 Curb & Sidewalk, Divisions B1, B2, B3, C1, and D1 Proj No. 120-001 - Premium Concrete Services, 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
Mr. Max Yeakey
Premium Concrete Services, Inc.
712 Richmond St.
Elkhart, IN 46516
maxkpremiumconcreteonline. com
PHoNE 574/235-9251
FAx 574/235-9171
RE: Change Order No. 1 (Final)/Project Completion Affidavit
2020 Curb & Sidewalk, Divisions B1, B2, B3, C1, and D1 — Project No. 120-001
Dear Mr. Yeakey:
The Board of Public Works, at its meeting held on October 27, 2020, approved the Final Change
Order for this project, for a decrease of $5,803.55. The new Contract sum is $196,409.45.
In addition, the Project Completion Affidavit for this project was approved in the amount of
$196,409.45.
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
ti \G
CITY OF SOUTH BEND, INDIANA
DEPARTMENT OF PUBLIC WORKS
PROJECT CHANGE ORDER N°
DATE: 9/24/2020
PROJECT NO: 120-001
PROJECT NAME: 2020 Curb & Sidewalk (Divisions B1, B2, B3, C1, & D1)
CONTRACT DATE: 5/2612020
CHANGE ORDER NO: 1 (Final)
SUBJECT OF CHANGE ORDER: PCR #1-Adjustment to final quantities.
All items completed substantially as planned.
See attached Comparison of Estimate for overruns and underruns.
The original contract sum
Net change by previously authorized change orders
The contract sum prior to this change order
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 dateltime
Extension of date/time by previous change orders
Date/time extension by this change order
New completion date/time
CONTRACTOR
on ' ctor Signature
MAI �P-Mn" V ,1
Printed Name and Title
Premium Concrete Services, Inc.
Company Name
712 Richmond
Address
Elkhart, IN 46516
City, State, Zip
$ 202,213.00
$ 0.00
$ 202,213.00
❑ Increased
X] Decreased $ 5,803.55
$ 196,409.45
2.87
2.87
8/31 /2020
0 days
0 days
8/31 /2020
RECOMMENDED FOR APPROVAL
%& 1le':! �&'
CONSTRXJCTION MANAGER
CITY OF SOUTH BEND
BOARD OF PUBLIC WORKS
Approved Date: October 27, 2020
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
YZ-
Joseph R. Molnar, Member
Therese J. Doran, Member
Jordan V. Gathers, Member
ATTEST:
C�liln'�L! �i�iift21iT
Linda M. Martin, Clerk
.o�xiT�4
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT �
PROJECT NAME 2020 Curb & Sidewalk (Divisions B1, B2, B3, C1 & D1)
PROJECT NO 120-001 FINAL COST $196 409.45
CONTRACT SIGNED 5/26/2020 MAINTENANCE AGREEMENT ENDS
Remove and replace concrete sidewalk, concrete curb, ADA curb ramps, and concrete
PROJECT DESCRIPTION _approaches at various locations within the City of South Bend.
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.
Executed thi, q day of ,PT, 201 Premium Concrete Services, Inc.
Company Name
Signature 712 Richmond
c
Company Address
¢ N
Printed Name Elkhart, IN 46516
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City, State, Zip
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WITNESSES:
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U O CO V_
Before me, the undersigned Notary Public in and for said country and state, personally appeared
z i LL
xNtA Cam( and acknowledged his/her signature to the above Project Completion Affidavit on
OD J cn z
w
the .7 q'�h _day of j • 201 0��.
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W 4 � Z a 0
Z O u�S v�
No4y Signature My Commission Expires
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'c! lC7l�vC1�
Q to U
Printed Name County of Residence (
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If the Contract*acgrporation, the following certificate will be executed.
wUI,
Y certify that I am Secretary of the Corporation executing this release; th
>_
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
C�orpo�ra jon by Authority of its governing body, and is within the scope of corporate powers:
eS cretary's Signature
f' IkX Corporate Seal
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.
/b vz&d- Date:
Construction Manager
BOARD OF PUBLIC WORKS APPROVAL Date: October 27, 2020
BOARD OF PUBLIC WORKS
Gary A. Gilm, President n —
Elizabeth A. Mmadik, Member
Joseph R. Molnar, Member
IKT i JJ_
Therese J. Doraa, Member
Jordan V. Gathers, Member
ATTEST:
8c"Id6 CP4mtGr
Linda M. Martin, Clerk
Project Number: 120-001
DEPARTMENT OF PUBLIC WORKS
DIVISION OF ENGINEERING
2020 Curb & Sidewalk (Divisions B1, B2, B3, C1, & D1)
Project Name: 1
Change Order #. _
DATE INITIATED: 10/2/2020 BPW DATE:
Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.).
Adjustment to Final Quantities.
Attachments: (List documents support change — required)
None
Amount of El Increase / ODecrease: $ 5,803.55
Previously approved Change Order(s): $ 0
Current Percent of Change: -2.87
New Total Amount: $ 196,409.45
Total Percent of Change: -2.87
Funding Secured From:
(filled out by PM)
RECOMMENDED BY:
Josh Ehmer
Project Inspector (Print Name)
REVIEWED BY:
Toy Villa
Construction Manager (Print Name)
APPROVED BY:
Engineering Project Manager (Print Name)
APPROVED BY:
Categories (Pick One):
❑ Scope of Work
❑ Differing Site Conditions, Changed Conditions
❑ Conflicted Specifications and Drawings
❑ Failed Materials
❑ Error
❑ Omission
M Final Quantity Adjustment
4--�
(Signature)
10/2/2020
(Date)
t1d& 10/02/2020
(Signature (Date)
(Signature)
(care/
City Engineer (Print Name)
(Signature)
(uare)
JANEEMTOWNER
NOTARY PUBLIC
SEAL
Final Waiver of Lien ELKHART COUNTY, STATE OF INDIANA
MY COMMISSION EXPIRES FEBRUARY 12,
COMMISSION NO.710399
State
eoofladian\a,'County of I C LKH Aa SS:
f ' 1 y )7 kcq - being duly sworn that he/she is the .
(Name of Officer) (Title)
of(n1Um ►�(� l E�_I�51�having contracted with UT l 0� JCU ICI obi r 1 i�
(Contractor) (Owner)
to famish certain materials and/or labor as follows;
for a project known as
4-
located at JAB\aI IS LOC AT(ON5 L&RA ( N1__ AE7 (3rV liF
and owned by
and does hereby further state on the behalf ofthe 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;
F AL WAIV ) that tbg� 5nal balance due from the contractor the sum of�/
uN I� Jl1( DU5�1lOFatt +klu1� I&EAZ M ($
❑ receipt of which is hereby acknowledged; or
14 the payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lien which shelf
become effective onlyuponreceipt 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 farther certifled that no other party has any claim or right to a
lien on account of any work performed or material famished to the undersigned for said project, and within the scope of this Affidavit
and Waiver of Lien.
�y—
f'Kfm l�m l/c f'lf�1U F 1 <X rz�j i;cc t Tg . By
(Firm) ' (Authorized Representative)
STATE OF INDIANA )
ak Az-r ) SS:
fI COUNTY
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien,
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the �q I r, day of
APT_ 201 4,C) M
mry Public Signature
My Commission Expires: 0A(- lcu(p
(`1 To(,JrJ�2
Residing in U=K AA County, 10 of A�_ Notary Public Name
*
* * * MAINTENANCE BOND
Bond No.MNT2420245
IfNOW ALL MEN BY THESE PRESENTS:
That, Premium Concrete Services, Inc., 712 Richmond St, Elkhart, IN 46516
as Principal,
and Old Republic Insurance Company , a corporation organized under
the laws of the State of Wisconsin and authorized to do a surety business in
the State of Indiana
as Surety, are held and firmly bound
unto the City of South Bend Board of Public Works , as obligee
in the slum of Nineteen Thousand Six Hundred Furry And 951100
($19,640.95 ), lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind
ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, fimily by these presents:
SEALED with our seals azid dated this 29th day of September , 2020
WHEREAS,
on the 26th day of
MaY
, 2020
,the
said principal as
contractor, entered into a contract for:
2020 Curb
and Sidewalk Construction,
(Divisions B1,
B2, 133,
Cl,
& DI), Project
No. 120-001
for the sum of Two I-lundred TwoThousand Two Hundred'1'hir[een And No/LOU
($2U2,213.00 I; and,
WHEREAS, under the terms
of the specifications for said work, the
said principal is required to give a bond
in theamount of Nineteen
Thousand Six Hundred lbrty And 95/10U
($$19 640.95
), to protect the
obligee against the result of
faulty materials or workmanship for a
period ofThree ravear(s) from and after
the date of the completion and
acceptance of same, namely,
until 9/24/2023
Now, THEREFORE, if the said principal shall for a period ofThree (3)7ear from and after the dale of the completion and acceptance of same
by said obligee replace any and all defects arising in said work whether resulting from defective materials or defcctive workmanship, then
the above obligation to be void; otherwise to remain in full force and effect,
Premium Conc to Services, lno.
B Principal
Y
Old Republic Insurance Company
Surety
ByO'_�
/ennifer L. Kasznia Attorney -in -Fact
ORSC 22513(4-93)
+ +,
OLD REPUBLIC INSURANCE COMPANY
+ *
* + * POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation,
does make, constitute and appoint:
NICOLE L BICKNELL, MEGAN E RIESENSERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM
J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEMER, LISA M THOMAS, FAITH HUNT, OF SOUTH BEND, IN
its true and lawful Attorney(s)-in-Fact, with unlimited power and authority for and on behalf of the Company as surety, to execute and deliver and affix
the seal of the Company thereto (ifa seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than
self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds,
- hazardous waste remediation bonds or black lung bonds) , as follows:
ALL WRITTEN INSTRUMENTS ;
and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and
confirmed. This appointment is made under and by authority of the board of directors at a meeting on December 10, 2019. This Power of Attorney is
signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC
INSURANCE COMPANY on December 10, 2019.
RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surely division, in conjunction with the secretary or
any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of
the Company may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such
persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds,
other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note
guaranty bonds. The said officers may revoke any Power of Attorney previously granted to any such person.
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be validand binding upon the Company
(i) when signed by the chairman, president or any vice president of the Company's surety division and attested and sealed (if a seal be
required) by any secretary or assistant secretary; or
(ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required).
RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any
Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship
obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its
corporate Seal to be affixed this 18TH day of FEBRUARY. 2020.
- OLD REPUBLIC INSURANCE COMPANY
Assistant Sretarq _W4ce`wS'� - —
SEALi;°
IL AS'AA
AVLAI
STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS '•••,,,,,,,,,,,,,,,,••• Vice President
On this 18TH day of FEBRUARY, 2020 personally came before me, ALAN PAVLIC and
SHEILA M. APPLEGATE to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who
executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that
they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate
seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said
organization. xnkvx� YL a Lis
l/ Notary Public
My commission expires: 9/ Z 8/ 2 2
(Expiration of notary commission does not invalidate this instrument)
CERTIFICATE
I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing
and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in
the Power of Attorney, are now in force.
45-5314 ��}}--
,,,•,��°""""'•".,, Signed and sealed at the City of Brookfield, WI this ��� � i day of f�Yi ,
�! SEAL ix-
o� i Assistant Secre as
GIBSON INSURANCE AGENCY, INC.
22851-8 POAOR10112020
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 10/02/2020
Name Toy Villa Department Engineering
BPW Date 10/13/2020 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 — Required. for 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.l Final ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
n Other: n Ease./Encroach
Information
Company or Vendor Name
Premium Concrete Services, Inc.
❑ Yes❑ If Yes, Approved by Purchasing
New Vendor
❑ No
❑❑
MBE/WBE Contractor
Neos
❑ WBE Completed E-Verify Form Attached
Project Name
2020 Curb & Sidewalk
Project Number
120-001
Funding Source
MVH
Account No.
V00000181
Amount
$
Terms of Contract
Purpose/Description
_Project Closeout
For Change Orders Only
Amount of ❑ Increase $
® Decrease ($ 5,803.55)
Previous Amount $ 202,213.00
Increase
Current Percent of Change:
Decrease
New Amount
$ 196,409.45
Increase
Total Percent of Change:
Decrease
Time Extension Amount:
New Completion Date:
87%
87%)