HomeMy WebLinkAboutChange Order No 1 & PCA - Walnut Grove and North Riverside Dr. Traffic Calming Proj No. 119-074 - 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
October 27, 2020
Mr. Max Yeakey
Premium Concrete Services, Inc.
712 Richmond St.
Elkhart, IN 46516
max(a)�premiumconcreteonline. com
PHoNE 574/235-9251
FAx 574/235-9171
RE: Change Order No. 1 (Final)/Project Completion Affidavit
Walnut Grove and North Riverside Dr. Traffic Calming — Project No. 119-071
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 an increase of $3,836. The new Contract sum is $81,336.
In addition, the Project Completion Affidavit for this project was approved in the amount of
$81,336.
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.
Enclosures
Sincerely,
s/Linda M. Martin, Clerk
October 27, 2020
GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR
CITY OF SOUTH BEND, INDIANA
DEPARTMENT OF PUBLIC WORKS
PROJECT CHANGE ORDER
DATE: 9/27/2019
PROJECT NO: 119-071
PROJECT NAME: Walnut Grove and North Riverside Drive Traffic Calmin
CONTRACT DATE: 8/22/2019
CHANGE ORDER NO: 1 (Final)
SUBJECT OF CHANGE ORDER: PCR #1-Concrete Pavement Removal and Backfill
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 date/time
Extension of date/time by previous change orders
Date/time extension by this change order
New completion date/time
CONTRACTOR
Contractor Signature
M'HY*AKC-,-J V.P.
Printed Name and Title
Premium Concrete Service, Inc.
Company Name
712 Richmond Street
Address
Elkhart, IN 46516
City, State, Zip
XI Increased
❑ Decreased
10/15/2019
0 days
0 days
10/1512019
77,500.00
0.00
77. 500.00
$ 3,836.00
$ 81, 336.00
4.95 %
4.95 %
RECOMMENDED FOR APPROVAL
%e t1d&
CONSTRLXTION MANAGER
CITY OF SOUTH BEND
BOARD OF PUBLIC WORKS
Approved Date: October 27, 2020
Gary A. Gilot, President
Elizabeth A. Maradik, Member
Joseph R. Molnar, Member
Therese J. Doran, Member
Jordan V. Gathers, Member
ATTEST:
-42111l,r C> 6727n
Linda M. Martin, Clerk
�'�yrre
CITY OF SOUTH BEND, INDIANA 77
� al
BOARD OF PUBLIC WORKS
Y �
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME Walnut Grove and North Riverside Drive Traffic Calming
PROJECT NO 119-071 FINAL COST $81,336.00
CONTRACT SIGNED 8/22/2019 MAINTENANCE AGREEMENT ENDS
PROJECT DESCRIPTION Installation of speed humps at various locations throughout the Citv.
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 theaboveContract,
�C[
Executed this S day of t 201 � Premium Concrete Service, Inc.
Company Name
4
ignature
712 Richmond Street
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Company Address
Printed Name
Elkhart, IN 46516
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City, State, Zip
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WITNESSESS:
Before the Notary
Q W
me, undersigned Public in and for said country and state,
personally appeared
ry)FF1p,X EA jC and acknowledged his/her signature to the above Project Completion Affidavit on
Wa u
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the d 1 day of `PT 20'4 ac)
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Nota Signature My Commission Expires
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Printed Name County of Residence
CL KA AR-7
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If the Contrar is a corporation, the following certificate will be executed. .
I, ct KjE , certify that I am Secretary of the Corporation executing this release, that
1C 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 i nature
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.
Date: 09/30/2020
Constructia Manager
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
7-
7-1-Joseph R. Molnar, Member
BOARD OF PUBLIC WORKS APPROVAL Date: October 27, 2020
�e_dytrr�.u-
Therese J. Doran, Member
Jordan V. Gathers, Member
ATTEST:
z iNAa ol("
Linda M. Martin, Clerk
State oflndione, County of
Final Waiver of Lien
JANEE M TOWNER
NOTARY PUBLIC
SEAL
ELKHART COUNTY, STATE OF INDIANA
MY COMMISSION EXPIRES FEBRUARY 12,
COMMISSION NO.710399
E(KNA& SS:
/y� /J
1 ' A x Y �iik� being duly sworn That he/she is the �P,
(Name of Officer) (Title)
mlufh�huingcontractedwithof �City of South Bend
(Contractor) (Owner)
to famish certain materiels andlor labor as follows:
£or a project known es
located et
and owned by
�lAelouslaJc+��IoNsiFleDllc�Nou7 �l�C.(r�
of South Bend
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is duo from the Contractor the sum of
❑ receipt of which is hereby actotowledged; or
❑ die payment of which has been promised as the sole considemtlon for this Affidavit and Final Waiver of Lienwhich is given
solely with respect to said amount, and which weivcr shall bDo 0 only upon receipt of payment thereof by the
undersigned;
FINAL WAIVER that the final balance due from the contractor is the sum of
❑ receipt ofwhioh is herebyacknowledged; 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
on the above•descxlbedproparty and improvements thereon an account of labor• or material or both, fmnished 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 off Liem e�f�
Tum lu ff kc T� ' Si Vt �I.Y By ,!�/
(Finn) (Authorized Representative)
STATE OF INDIANA )
SS:
&3BSEPH COUNTY )
Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared
end aelatowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WHEREOF, Ihavc hereunto subscribed my name and affixed my official seal on the � day of
y zoo sue_ �10 t m Qxokul
taty Pu61ic Signaturo
MyCanmissionEkpires: OoZIIaI x�� �� � ������
Residing in RA County, 7AJDIJglk3A Notary Public Name
MAINTENANCE BOND
Bond No. MNTzazozas
KNOW ALL MEN BY THESE PRESENTS:
Premium
Concrete Services, Inc., 712 Richmond S[, Elkhart, IN a6s16
as Principal, hereinafter call Contractor, and Old Republic Insurance Con
Brookfield, WI
as Surety, hereinafter call Surety,
are held and firmly bound unto
City of South Bend
Board of Public Works as Obligee,
hereinafter called Owner, in the
penal sum of
for the payment whereof Contractor and Surety bind themselves, their heirs, executors,
administrators, successors, and assigns, tly and severally, firmly by these presents.
WHEREAS, Contractor has by written agreement, dated August 22, 2019
entered into a contract with Owner for Walnut Grove and North Riverside Traffic Calming ,
in accordance with the General Conditions, the Drawings and Specifications, which contract is by reference incorporated herein,
and made a part hereof, and is referred to as the Contract.
NOW, THEREFORE, the condition of this obligation is such that, 'd Contractor shall remedy any defects due to faulty materials or
workmanship, and pay for any damage to other work resulting therefrom, which shall appear within a period of three (2 year(s)
from the date of substantial completion of the work provided for in the Contract, then this obligation to be void; otherwise to
remain in full force and effect.
Bond shall be effective from September 10, 2020 to September 10, 2023.
PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable promptness.
SIGNED and sealed this 1 lth day of September 2020
Premium Concrete Services, Inc.
Principal
By � (Seal)
Old Republic Insurance Company
(Seal)
Vfifer L. asznia
OLD`REPLJBI;1(' Sl'Itll;rl N' COMPANY
,v *
.*r
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLICSURETY COMPANY, a Wisconsin stock insurance; corporation, does make, constitute and
appoint
NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM
J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIBER, CHERYL E. ALKIRE, OF. SOUTH BEND, IN
its tine and lawful Attorny(s)-in-Fact, with full power and authority, not exceeding $50,000,000, for and on behalf of the company as surety, to execute and deliver
and affix the seal of the company thereto (if a seal is requited), bonds, undertakings, recognizances or other written obligations in the nature thereof, p,i hct thou b:tl l
imince w m kci:v
WIN or black uni
asfollows:
ALL WRITTEN INSTRUMENTS
and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed
tnisd v.-- il�.oet W111d rilit sdl' iedoicolr Ibackr,mnirda d-, molitculocd. This appointment is made under and by authority ofthe board ofdirectors
at a special meeting held on February 18, 1982. 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 SURETY COMPANY on February 18, 1982.
RESOLVED that, the president; any vice-president, or assistant vicepresident, in conjunction with the secretary or any assistant secretary, may appoint
atlomeys-in-Fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company, to
execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may remove
any such attomey-in-fact or agent and revoke any Power of Attorney previously granted to such person.
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
(i) when signed by [he president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by anysecretary or assistant -
secretary; or
(if) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be
required) by a duly authorized attomey-in-fact or agent; or
(iii) when duly executed and sealed (if a seal be required) by one or more altomeys-in-fact or agents pursuant to and within the limits of the authority
evidenced by the Power of Attorney: issued by the company to such person or persons
RESOLVED FURTHER, that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Powerof 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 SURETY COMPANY has caused these presents to be signed by its proper officer, and. its corporate. seal to 6e
affixed this I ITH day of JUNEt 2019.
Y y... i? 1.- OLD REPUBLIC SURETY COMPANY
SEAL
STATE OF WISCONSIN, COUNTY OF WAUKESHA-SS President
On this I ITH day of JUNE, 2019 ,personally came before me, 'Alan Pavlic .and
Jane E Chesney ,tome (mown to beYhe individuals andbfficers ol'the OLD REPUBLIC.SURETY COMPANY who executed the above.
instrument, and they each acknowledged the execution of the same, and being by me duly swom, did severally depose and say; that they are the 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 saidinstrument by the authority of the board of directors of said corporation..,.
Notary Public
My commission expires: 9/28/2022
CERTIFICATE (Expiration of notary commission does not invalidate this instrument)
1, the undersigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin 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 a �u avpe Signed and sealed at the City of Brookfield, WI this �( _ day of,
� SEALGIBSON INSURANCE AGENICY� INC.
AtfiliKk
AS A COLORED BACKGROUND ANO IS MULTICOLORED ON THE FACE. THE COMPANY LOGO APPEARS 6N THE
,� ypti I H "e4;v
180
Project Number: 119-071
DEPARTMENT OF PUBLIC WORKS
DIVISION OF ENGINEERING
Project Name:
Walnut Grove and North Riverside Drive Traffic Calming Change Order #: 1
_
DATE INITIATED: 9/30/2020 BPW DATE: 10/13/2020
Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.).
There was concrete pavement underneath the existing asphalt along Riverside Dr. The concrete
was removed and backfilled with stone to the proper grade.
Attachments: (List documents support change — required)
N/A
Amount of Dlncrease / El Decrease: $ 3,836.00
Previously approved Change Order(s): $ 0.00
Current Percent of Change: 4.95
New Total Amount: $ 81 , 336.00
Total Percent of Change: 4.95
Funding Secured From:
(filled out by PM)
RECOMMENDED BY:
Dan Jones
Project Inspector (Print Name)
REVIEWED BY:
Toy Villa
Construction Manager (Print Name)
APPROVED BY:
Theresa Harrison
Engineering Project Manager (Print Name)
APPROVED BY:
Kara Boyles
Categories (Pick One):
❑ Scope of Work
0 Differing Site Conditions, Changed Conditions
❑ Conflicted Specifications and Drawings
❑ Failed Materials
❑ Error
❑ Omission
❑ Final Quantity Adjustment
G�
(Signature)
�1 WTI Will
(L)ate)
Z� j/4& 09/30/2020
(Signatu ) (Date)
TA&rff0, e. HGLf"f^liSrU'f'li
(Signature)
(care)
City Engineer (Print Name)
(Signature)
(care)
Date 10/ 14/2020
Name Toy Villa Department Engineering
BPW Date 10/27/2020 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 Tvne — Reauired for All Submissions
U Professional Services Agreement U Contract U Proposal
❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA
❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise
❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes
❑ Proposal Opening ® C/O & PCA No. I (Final) ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
❑ Other: ❑ Ease./Encroach
Reauired Information
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Premium Concrete Services, Inc.
❑ Title
Sheet
U Yes U If Yes, Approved by Purchasing
® No
❑ MBE Completed E-Verify Form Attached ❑ Yes
❑ WBE ❑ No
Walnut Grove and North Riverside Drive Traffic Calming
119-071
LRSA
251.0608.431.42.96
$81,336.00
Project Closeout
For Change Orders Only
Amount of ® Increase $ 3,836.00
❑ Decrease ($ )
Previous Amount $ 77,500.00
Current Percent of Change:
New Amount
Total Percent of Change:
Time Extension Amount:
Increase 4.95%
Decrease ( %)
$ 81,336.00
Increase 4.95%
Decrease ( %)
New Completion Date: