HomeMy WebLinkAboutChange Order Nos 4 & 5 - Corby, Ironwood, Rockne Intersection Improvements - Rieth-Riley Construction1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
November 10, 2020
Mr. Joshua McCormick
Rieth-Riley Construction Co., Inc.
25200 State Road 23
South Bend, IN 46614
j mcc ormickgrieth-rile,
PHoNE 574/235-9251
FAx 574/235-9171
RE: Change Order Nos. 4 & 5 — Corby, Ironwood, Rockne Intersection Improvements
Project No. 116-034
Dear Mr. McCormick:
The Board of Public Works, at its meeting held on November 10, 2020, approved the Change
Order No. 4 for an increase of $1,592.85, bringing that current contract amount to $3,137,321.85.
The Board of Public Works also approved the Change Order No. 5 for an increase of $12,327.92,
bringing the current contract total amount to $3,148,056.92.
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 # 4 is for an additional $1,592.85 to change out 8 signal head visors on Rockne
after it was installed and to remove the banner arms from the streetlights after instillation.
Change Order # 5 is for an additional $12,327.82 to repair irrigation lines that were damaged
during construction.
Both changes orders 4 and 5 are not federally participating and as a result will be 100% locally
funded.
It is requested the Board of Public Works approve Change Orders 4 and 5 for the Corby,
Ironwood and Rockne project (PN 116-034) for an increase of $13,920.77 bringing the new
contract price to $3,176,582.47.
Thank you for your consideration of this request.
Contract No:R -39540 Change Order No.: 004
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -39540 Letting Date:03,104/2020
District:LAPORTE DISTRICT AE:Patterson, Patrick PE/S:Wills, Dale Status:Pending
Change Order Information Change Order No.: 004 EWA: Y or Force Acct: N
Date Generated: 09/29/2020 Date Approved: 00i00/0000
Reason Code: ERRORS & OMISSIONS, Spec Related
Description: Added Traffic Signal Head & Light Pole Work
Original Contract Amount $ 3,135,729.00
Current Change Order Amount $ 1,592.85 Percent: 0.051 %
Total Previous Approved Changes $ 0.00 Percent: 0.000 %
Total Change To -Date $ 1,592.85 Percent: 0.051 %
Modified Contract Amount $ 3,137,321.85
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 SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:___ DCE: SCE: DDCM:
SS Days SP Days Value $
Revised Contract Time 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.: 004
Page: 2
AE: DCE: SCE: * DDCM:
(-LE$250K-)(-LE$750K-)(--LE$2M--)(--GT$2M--)
( 50 SS days) ( 100 SS days ) ( 200 SS Days } ( GT 200 SS days)
Y / N If Y, by Date Issued
Y / N If Y, Copy to Program Budget Manager
Y / N If Y, Referred to Project Manager(PM)
Date to PM
Approval Authority Concurs with PM? Y / N If Y, Concurrence by
If N,Resolution: Approved
LPA Signatures Required?
Resolved by
Y / N If Y, Date to LPA
Date Returned
Date
Disapproved_
Date
Date Retumed
FHWA Signatures Required? Y / N If Y, Date to FHWA Date Returned
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer
Comments:
Date
Contract No:R -39540
Change Order No:004
INDIANA
Department of Transportation
Date:09/29/2020
Contract: R -39540
Project: 1600074 - State:160007400LC4
Change Order Nbr: 004
Change Order Description: Added Traffic Signal Head & Light Pole Work
Reason Code: ERRORS & OMISSIONS, Spec Related
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
Page: 3
0150 1600074 0150 105-06807 LS 1,592.850 1.000 C Amcurt:$ 1,592,85
Item Description: ADDITIONAL
Supplemental Descrlption1: Traffic Signal Head Visor and Ught Pole Banner Arm Work
Supplemental Description2:
Total Value for Change Order 004 = $1,592.85
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 requested that the traffic signal head visors be changed for the Rockne Df, eastbound signals. New visors were provided
by the City. The cost to do this work was $565.19. The City of South Bend also requested that the light pole banner mounting brackets be
removed from the light poles. The cost to do this work was $1,027.66.
Change Order Explanation for Specific Line Item
1T1YfftTRY##Y#1rtYf#Y/Yt •f!Y/f a f!Y•fiYYffM f##f f Yf /f ff •!#/Rf iff f-fY##Y##ftiNYNYHitx#t11 k#Y#f Yi#Rf ffR#MY#f### #HY###Ytt Y#tvY
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. /
Contractor: 1 Cr Signed By: )C
Date: 36 - Zo
NOTE: Other required State and FH WA signatures will be obtained electronicaily through the SkeManager system.
Contract No:R -39540 INDIANA Date:09/29/2020
Change Order No:004 Department of Transportation Page: 4
tHflHlM!!H!fltHYHr!!flrtf!};*rfr'Iff11fAtrNY+'+rHfHtHHtH+HRrHr+rN#rrr+6+rk+++fAxHtx++irH11aH H+r+H+H rH+iH e
BOARD OF PUBLIC WORKS APPROVED FOR LOCAL PUBLIC AGENCY
C
Gary A. Giloy Preaidem
-&;A ,:Wk
Blizabelh A. M—dik, Member
,-- 7'rZ_
JosephR. Mdh Member
Therese J. JNrcao, Member
Jordan V. Gathers, Member
ATTEST:
Z"& Cw.vx
Linda M. Martiq Clerk
SUBMITTED FOR CONSIDERATION
HfHH rr+rrrw HHHrHHHrrr+r+++rfH rrr• Hrr*f arfrrw •wHff+rt HHw+frrH.+twrf++rrw r++:+++++Y+• w H k++f a Y rrw+rw++l+++Y+ff t
November 10, 2020
(DATE)
(DATE)
APPROVED FOR fNDIANA DEPARTMENT OF TRANSPORTATION
Approval Level
Name of Approver
Date
Status
Project Engineer/Supervisor
Patterson, Patrick
00/00/0000
Action Pending
1ETHj
ILEY CONSTRUCTION CO., INC.
1000/o Quality • 100% Employee Owned • Over 100 Years
September 21, 2020
Mr. Dale Wills
Lochmueller Group
112 W Jefferson Blvd
Suite S00, South Bend, IN 46601
RE: R-39540-A, Remove Banner Arms
Dear Mr. Wills
The total cost for the work associated with removing the banner arms off the light poles was as follows.
Total amount requested = $1,027.66
Please consider this as our formal request for a Change Order to add this work to the contract. Please let me
know if you have any questions. Thank you for your consideration on this matter.
Respectfully Submitted,
Jamie Plunkett
Project Manager
Rieth Riley Construction Company
25200 S.R. 23 • South Bend, IN 46614
Phone: (574) 288-8321 • www.neth-riley.com
CHANGE ORDER REQUEST FORM
CONTRACT R-38540 DATE OF
:3eptellnber''
NO. SUBMISSION 21,
NOTE: Upon request from Engineer, enter detailed description on page 2.
ONSET DATE OF CHANGE AmOuSt 2020 CHANGE ORDER TYPE %104:03 ExtraWork:.;
PROPOSED COST AND TIME ADJUSTMENT
COST COST INCREASE / (DECREASE): $ 1,.027.66'.
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:
D 109.03 Altered Qyantitles 13-109.05(a} Agreed price ®109.05(b) Force Account D 109.05.OZ.DelayGosts..
PROPOSED COST CHANGE INCLUDES: 0.1abor 0.0aterial 0 quipmerit . Q Lease Agreement
Subcontractor
TIME ADJUSTMENT INCREASE/(DECREASE): (work days)N/A
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
i].108.OS(aj Excusable, ln-Cornpensable.'_ .08(b) Excusable, Compensable
NOTE: if Compensabk, attach details based on 109.m.2(a) Allowable Delay Costs.
SUPPLEMENTAL INFORMATION
Additinnal Informatinn may ha s+nfamd by tha rnntr�.tn�
CHANGE ORDER ORIGINATION:
t INDOT-/ LPA .:: 0 Contractor '--_
DOCUMENTS AFFECTED:
❑ Contract Specifications (ref. doc name/no.)
Clic .here to enter text
❑ Contract Plans (ref. doc name/no.)
Clli here to enter text- .
CHANGE ORDER AFFECTS DBE PARTICIPATION:
❑ yes ® no (if yes, attach details)
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
[Select Date]
SUBMITTAL DATE OF
[Select Date]
ADDITIONAL DETAIL
ADDITIONAL DETAIL
DETAILED DESCRIPTION / JUSTIFICATION:
(include location(s), actions of contractor, owner, and other stakeholders, key events and related cause(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 hereto 9nter.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 herd to entertext
SIGNATURES
Contractor: _yy
Name: (print) J
(signature)
Date: 6t ^ 2 1 - zo 20
Project Engineer/Supervisor: (signature is to acknowledge receipt of the document and does not signify agreement of the change order)
Name: (print)
(signature)
NOTE. The Contractor and PENS should retain a signed copy of this document for record.
Date:
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: 9/22/20 WORK PERFORMED: Hawk, Removed flag banners
CONTRACT: 39540 PROJECT: 39540
FORCE ACCOUNT/EXTRA WORK FOR: Ironwood and Corby
Hawk removed flag banners off of each light pole.
LABOR 109.05 (b)(11
Hnl IRS
EMPLOYEE
Regular
Overtime
Doublebme
TOTAL
RATE
EXTENSION
ENGINEER
0.00
$35.00
$0.00
FINISHER, CRAFT FOREMAN ELKHART/ST JOE
0.00
$35.15
$0.00
FINISHER, CRAFT FOREMAN LAPORTE
0.00
$36.59
$0.00
FINISHER, JOURNEYMAN ELKHART/ST JOE
0.00
$32.90
$0.00
FINISHER, JOURNEYMAN LAPORTE
0.00
S33.59
$0.00
FOREMAN, LABORER,ELKHART/ ST. JOSEPH
0.00
0.00
S43.20
$0.00
FOREMAN, ESOP
0.00
S44.20
$0.00
FOREMAN, FINISHER. ELKHART / ST. JOSEPH
0.00
S35.15
$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
0.00
$26.10
$0.00
LABORER, LAPORTE
1 0.00
$31.91
$0.00
MECHANIC
0.00
$42.20
$0.00
OPERATOR, ELKHART
0.00
$31.15
$0.00
OPERATOR, LAPORTE / ST. JOSEPH
1
0.00
S42-20i
0.00
QA TECH
0.00
$26.10
$0.00
PROJECT SUPERINTENDENT
0.00
S50.00
$0.00
TEAMSTER
0.00
$30.91
$0.00
FRINGES
TOTAL LABOR $0.00 (2)
FICA 7.50 % x LINE (2j $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
$36.101
CM
OPERATOR, ELKHART
0-00
X
$30.21
=
$0.00
OPERATOR, LAPORTE / ST. JOSEPH
0.00
x
$36.10
=
$0.00
QA TECH
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 $0,00 (4)
WORKERS COMPENSATION 5.72 % X
LINE (2)
$0.00 (5)
BODILY INJURY/ 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 & 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)
Purchased or
Manufactured
Description
Quantity
Unit
Unit Price
Extenstion
$ 240.00
$
$
$
$
$
$
s
$
$
MATERIALS PURCHASED
MATERIALS MANUFACTURED
TOTAL: LINE (18) + (19)
12 % x LINE (20)
GRAND TOTAL FOR MATERIALS: LINE (20) + (21)
EQUIPMENT 109.05 (b)(4)
$0.00 (18)
$0.00 (19)
$0.00 (20)
S0.00 (21)
$0.00 (22)
Equipment N
CONTRACTOR OWNED EQUIPMENT
FHWA HOURLY RATE
HOURS
EXTENSION
$0.00
$0.00
0.00
$0.00
$o.00
$0.00
$0.00
$0.00
$0.00
SO.00
$0.00
S0.00
$0.00
S0.00
$0.00
S0.00
$0.00
S0.00
Trucking - Striaght Time
$0.00
S0.00
Trucking -Over Time
$0.00
$0.00
Trucking - Double Time
$0.00
0. 00
TOTAL EQUIPMENT
S0.00
(23)
TOTAL TRUCKING
$0.00
(24)
FUEL, LUBRICANTS AND TRANSPORTATION COSTS
$0.00
(25)
TOTAL LINES (23) + (24) + (25)
$0.00
(26)
12 % x LINE (26)
S0.00
(27)
GRAND TOTAL FOR EQUIPMENT: LINES (26) + (27)
$0.00
(28)
SUBCONTRACTORS 109.05 (b)(6)
Removed
TOTAL SUBCONTRACT WEEK ENDING
7 % x LINE (30)
GRAND TOTAL FOR SUBCONTRACTORS: LINES (30) + (31) + (32)
TOTAL OF WORK COMPLETED FOR THE WEEK
$948.95 (29)
$66.43 (31)
$0.00 (32)
$1,015.38 (33)
TOTAL LINES (12). (17), (22), (28) 8 (33) $1 ,015.38 (34)
1.1 % OF BOND RATE BASED UPON LINE (34) $11.17 (35)
10 % x LINE (35) S1.12 (36)
TOTAL EXTRA WORK LINES: (34)+ (35)+ (36) $1,027.66 (37)
Page 2 of 2
` Remove banner arms off of light poles.
Rates Updated:
LaborOZ.
Hours
Rate
Burdens
Total
General Foreman
$57.47
$33.66
$91.13
Foreman
4
$50.38
$30.35
$80.73
Lineman
$45.98
$28.29
$74.27
Equipment Operator
$45.98
$28.29
$74.27
Groundman Equip.Operator
4
$44.53
$27.61
$72.14
Senior Groundman Truck Driver
$31.88
$21.70
$53.68
Groundman
$26.56
$19.21
$45.77
E_Quipment
Rates Updated: 1/2119
Labor Total
Description
Hours
Rate
On -Highway Light Duty Truck
$21.88
On -Highway Flatbed Truck
$34.10
On -Highway Rear Dump
$40,18
Wheel Mtd. Hyd. Excavator
$95.45
Truck w/ Articulating Lift
4
$48.03
Truck w/ Teleoscopic Lift
$58.58
Trailer
$11.16
Skid Steer Loader
$32.91
Generator
$5.40
Cut-off Saw
$2.64
Conduit Bender
$8.01
Air Compressor
$17.36
Walk -Behind Saw
$22.31
Crack Filler (Loop )
$10.27
Directional Boring Machine
$93.43
Boring Truck
$47,57
INNO 1ZR fusion splice kit
$10,22
EXFO Fiber inspection pro
$5.78
EXFO 720C
$8.04
INTECH 8x12 TA2
$15.28
Material
1
2.
3.
4.
5.
6.
Description
Sub Totals
Labor Total $611.48
Equipment Total $192.12
Material Total $0.00
Equipment Total
Quantity Cost
Material Total
+ mark-up
$122.30
$23.05
$0.00
Total:
1/1/2020
Subtotal
$0.00
$322.92
$0.00
$0.00
$288.56
$0.00
$0.00
$611.48
Extension
$0.00
$0.00
$0.00
$0.00
$192.12
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$192.12
Extension
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$733.78
$215.17
$0.00
$948.95
Amho
EquipmentlNatch-
www.equlpm entwalch.00m
All prices shown in US dollars ($)
Adjustments for 4M9-B in All Saved Models September21 2020
Miscellaneous 68150
Articulating Boom Aerial Lifts For Truck Mounting g y
Size Class:
41-Nft
Weigh:
NIA
Configuration for Ba150
Boom Conflguratlon
Overcenter
Material Handling No
Maximum Platform Height
41.0. 50.0 ft
Blue Book Rates
FHWA Rate Is equal to the monthly ownership coat d vided by 176 plus the heady esdmated operating cost.
Ownership
Cost$ Estimated
FHWA Rate -
Operating Costs
Monthly
Weekly
Daily Hourly Hourly
Hourly
Published stales
USD $1,995.00
U57 $500.00
USD $140.00 USD $21.00 USD $3.94
USD $15.28
Adjustments
Region (Indlana: 99%)
(USD $19.96)
(USD $5.60)
(USD $1.40) (USD $0.21)
Model Yea
(USD $142.91)
(USD $40.12)
(USD $10.03) (USD $1.H0)
(2009: 92.76%)
Adjusted Hourly
-
-
- -
Owneaship Cost (100%)
Hourly Op9miling Cost (1001%)
Total:
USD $1,832.14
USD $614.28
USD $128.57 USD $19.29 USD $3.94
USD $14.35
Nan -Active Use Rates Hourly
Standby Rate USD $5.20
Idling Rate USD $10.41
Rate Element Allocation
Element
Dep eclation (ownership)
Overhaul (ownemhfp)
CFO (ownership)
Indirect (ownership)
Revised Date: 2nd half 2020
Percentage
56%
22%
4%
131%
Fuel cost data Is not available for these rates.
value
USO $1,318.70/mo
USD S438.90/mo
USD $79.80/mo
USD $159.60Im0
These are the most accurate rates for the selected Revision Date(s). However, due to more frequent online updates, these rates may nut match
Rental Rate Bkre Book Print. Visit the Coat Recovery Product Guide on our Help page for more information.
The equipment represented in this report has been exclusively prepared for MARY MASTRANTONIQ
(mary@hawk-inc.com)
All material herein 02003-2020 Informa All rights reserved.
IETH! IL E Y CONSTRUCTION CO., INc.
100% Quality • 100% Employee Owned • Over 100 Years
September 22, 2020
Mr. Dale Wills
Lochmueller Group
112 W Jefferson Blvd
Suite S00, South Bend, IN 46601
RE: R-39540-A, Install Tunnel Visors
Dear Mr. Wills
The total cost for the work associated with installing tunnel visors was as follows.
Total amount requested = $565.19
Please consider this as our formal request for a Change Order to add this work to the contract. Please let me
know if you have any questions. Thank you for your consideration on this matter.
Respectfully Submitted,
Jamie Plunkett
Project Manager
Rieth Riley Construction Company
25200 S.R. 23 • South Bend. IN 46614
Phone: (574) 288-8321 • www.rieth-ritey.com
CHANGE ORDER REQUEST FORM
CONTRACT 0 DATE OF September
NO. SUBMISSION 22,2020
NOTE: Upon request from Engineer, enter detailed description on page 2.
ONSET DATE OF CHANGE September_.1, 2020 CHANGE ORDER TYPE F 104.03 Extra Work
PROPOSED COST AND TIME ADJUSTMENT
COST
COST INCREASE / (DECREASE):
$ 565.19:
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:
D 109.03 altered Quantities Q t.09 05(a) Agreed Pnce Z 109.05(b) Force Account {] 109.05.02 Delay Costs.
PROPOSED COST CHANGE INCLUDES: Cl Latior Material ; Equipment . ❑Leas*' Agreement
Subcontractor
TIME ADJUSTMENT INCREASE / (DECREASE): (work days) N/A
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
0 108.08(a) Excusable Non-CAmpensable-0108.08(b) Excusable, Corn erasable
NOTE: if Compensable, attach details based on 109.05.2(a) Allowable Delay Costs.
SUPPLEMENTAL INFORMATION
Additinnal lnfnrmatinn may hn entered by the nnntrartnr
CHANGE ORDER ORIGINATION:
,® .INDOT/-LPA ❑ Contractor .
DOCUMENTS AFFECTED:
❑ Contract Sped icatlons (ref. doc name/no.)
Caick here to enter
❑ Contract Plans (ref. doc name/no.)
Click here W enter text
CHANGE ORDER AFFECTS DBE PARTICIPATION:
❑.yes ® no..(Ifyes, attach details) '
Ver. 10.23.17
CHANGE ORDER REQUEST FORM
CONTRACT NO. R�3S540.
UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL
DATE RECEIVED REQUEST FOR " SUBMITTAL DATE OF
[$elect Date]
[Select Date]
ADDITIONAL DETAIL ADDITIONAL DETAIL
..
DETAILED DESCRIPTION / JUSTIFICATION:
(Include location(s), actions of contractor, owner, and other stakeholders, key events and related cause(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"hefe to: enter text.
SIGNATURES
Contractor:
Name: (pi
(signature
Date: ' -22 - 2020
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/5 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: 9/22/20 WORK PERFORMED Hawk Install Tunnel Visors
CONTRACT: 39540 PROJECT: 39540
FORCE ACCOUNT/EXTRA WORK FOR: Ironwood and Corby
install tunnel visors provided bV city of south bend.
LABOR 109.05 (b)(1)
EMPLOYEE
Regular
Overtime
Doublefime
TOTAL
RATE
EXTENSION
ENGINEER
0.00
$35.00
$0.00
FINISHER, CRAFT FOREMAN ELKHART/ST JOE
0.00
$35.15
$0.00
FINISHER, CRAFT FOREMAN LAPORTE
0.00
$36.59
$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
0.00
S43.20
$0.00
FOREMAN, ESOP
0.00
$44.20
$0.00
FOREMAN, FINISHER. ELKHART I 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
0.00
S26A0
$0.00
LABORER, LAPORTE
0.00
S31.91
$0.00
MECHANIC
0.00
$42.20
$0.00
OPERATOR, ELKHART
0.00
$31.15
$0.00
OPERATOR, LAPORTE / ST. JOSEPH
0.00
S42.20
$0.00
DATECH
0.00
$26,10
$0.00
PROJECT SUPERINTENDENT
1 0.00
I S50.001
$0.00
TEAMSTER
1 0.00
1 $30-911
$0.00
FRINGES
TOTALLABOR
FICA 7.50 g; x LINE (2)
$0.00 (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
CA TECH
0.00
x
$16.38
=
$0.00
PROJECT SUPERINTENDENT
0.00
x
$12.79
=
$0.00
TEAMSTERI
0.00
X
$16.54
=
$0.00
TOTAL FRINGES $0.00 (4)
WORKERS COMPENSATION
5.72
% X
LINE (2)
$0.00 (5)
BODILY INJURY 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 & 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)
Purchased or
Manufactured
Descnption
Quantity
Unit
Unit Price
Extenslion
$ 240.00
S
$
$
$
$
$
s
$
s
MATERIALS PURCHASED
MATERIALS MANUFACTURED
TOTAL: LINE (18) + (19)
12 % x LINE (20)
GRAND TOTAL FOR MATERIALS: LINE (20) + (21)
EQUIPMENT 109.05 (b)(4)
$0.00 (18)
$0.00 (19)
$0.00 (20)
$0.00 (21)
$0.00 (22)
Equipment k
CONTRACTOR OWNED EQUIPMENT
FHWA HOURLY RATE
HOURS
EXTENSION
$0.00
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Trucking - Striaght Time
$0.00
S 0.00
Trucking - Over Time
$0.00
$0.00
Trucking - Double Time
$0,00
50.00
SUBCONTRACTORS 109.05 (b)(6)
Install Tunnel Visors
TOTAL EQUIPMENT
$0.00
(23)
TOTAL TRUCKING
$0.00
(24)
FUEL, LUBRICANTS AND TRANSPORTATION COSTS
$0.00
(25)
TOTAL LINES (23) + (24) + (25)
$0.00
(26)
12 % x LINE (26)
$0.00
(27)
GRAND TOTAL FOR EQUIPMENT: LINES (26) + (27)
$0.00
(28)
TOTAL SUBCONTRACT WEEK ENDING $521.90 (29)
7 % x LINE (30) $36.53 (31)
$0.00 (32)
GRAND TOTAL FOR SUBCONTRACTORS: LINES (30) + (31) + (32) $558.43 (33)
TOTAL OF WORK COMPLETED FOR THE WEEK
TOTAL LINES (12), (17), (22). (28) & (33) $558.43 (34)
1.i % OF BOND RATE BASED UPON LINE (341 $6.14 (35)
10 % x LINE (35) $0.61 (36)
TOTAL EXTRA WORK LINES: (34) + (35) + (36) $565.19 (37)
Page 2 of 2
I Route: Section: County. St. Joseph District:
q Force Account bill for: Went to LaPorte to get tunnel visors, installed them on NE and EB signals on mast arm
Cn
b
CrJ
O
r�. Contract 39450 Project: Corbe, Ironwood, & Rockne Payroll Amount
Eligible for
Mon Tue Wed Thu Fri Total Hours Payroll Earnings Unemployment Tax
(D _ September 2020 7 8 9 '10 11 S.T. O.T. Rate Amount To Date F.U.T. S.U.T.
Gen_ Foreman
0.0
0.0
$
57.47
$
$ _ $
O
Foreman Jack May
3.5
2.5
1.0
$
50,38
$
201 52 $ 82,667.OD
$ - $
Foreman
0.0
0.0
$
50.38
$
g _ $
►r�1
Journeyman
0.0
0.0
$
45.98
$
$ _ $
�t
Equip Oper 4
0,0 .0
0.0
$
45.98
$
-
$ _ $
•
Equip Oper 3
0.0
0.0
$
44.53
$
F
Grm-Skilled
0.0
0.0
$
36.78
$
-
Z
Sr Gm Tk Dry
0.0
0.0
$
31.88
$
-
$ $
Subtotals: Labor
$
201.52
$ $
CA
Gen. Foreman Pension & Welfare Funds:
hours @
23.46
$
-
O
Foreman Pension & Welfare Funds:
3.5 hours @
21,40
$
74.90
Journeyman Pension & Welfare Funds:
hours @
20.12
$
_
"C
Groundman Pension & Welfare Funds:
hours @
17.46
$
_
Trainee Pension & Welfare Funds:
hours @
12.43
$
-
0
Subtotals: Labor
$
276.42
M
Plus 20% of
$ 276.42
$
55.28
N
�+
Subtotals: Labor
$$
331.70
zo
Plus Workman's Comp. Insurance
2.649% of $ 176.33
$4.67
Public Liability and Property Damage
tv
Insurance, excluding payroll of
0
Truck Drivers
O
Federal Unemployment Tax
0.60% of $ -
$0.00
State Unemployment Tax
7.400% of $ -
$0.00
Federal Social Security Tax
7.65% of $ 201.52
$15,42
Total Payroll Additives
$26.09
Fes-+
Plus 10% of
$ 20.09
$2.01
cr
$22.10
$22.10
Total Labor
$3.53.80
N
I hereby certify that the above statement is a copy of that portion of the payroll which applies
to the above state work,
and that the rates shown
C
for taxes and insurance are actual costs.
to
(Signed)
(Signed)
.14
(Res. Engineer)
V (Contractor)
X I
'0
a -I
(61
Tota I
Equipment Expense 7
8 9 10 11 Hours
Rate
Amount
Bucket Truck
3.5 3.5
$ 33.68 S
117.88
Articulating Boom
3.5 3.5
$ 14,35 $
50.23
0
$
0
$
-
0
$
0
$
_
0
$
0
$
-
0
$
0
$
_
0
g
_
0
$
0
$
C
$
_
0
$
_
0
$
_
0
$
_
Total Equipment Expense
$
168.11
Subcontractor Expense
S
-
Subtotal, Subcontractor
$
-
Plus 12% of $
_
$
-
Total Subcontractor
$
This is to certify that the material entered on this force account bill which was taken from stock Is shown at our cost.
Hawk Enterprises, Inc.
(Company)
By:
Total Labor:
$
353.80
Total Equipment Expense:
$
168.11
Total Subcontractor:
$
_
Total:
S
521.90
Bond:
0.75%
Plus 10% of:
$
Total Bill:
$
521.90
Resident
SNi'ERPAtFliS lIJ�.
1850 E. North Street
Crown Point, IN 46507
Q I I " Q2aIr
j ,
Contractor
Report No. Dlwc 11 ^Z.3
Authorization No.
Extra Work Da 'Reliort
County S-T
311-�='
0
Route -�. �J� L,->Ocr�
Disvl,t 3959 o
Convact No.
Job No.
Project -
EQUIP ENT USED
MATERIAL USED
Description: Number of
List MBrtufacturar Model Date_ Capacity Hours
_
Description Quantrry
REMARKS:
APPROVE �/� APPROVED:
ontractvr's Represent"' i State's Represenrative
3 C 535 t Rev 6-77)
L 494- 0426
Original: Constractur
M. Distrct He
CC: District no
mAgr-All,j
i
Contract No:R -39540 Change Order No.: 005
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.: 005 EWA: Y or Force Acct: N
Date Generated: 09/29/2020 Date Approved: 00/00/0000
Reason Code: ERRORS & OMISSIONS, Special Prov Related
Description: Lawn Irrigation Repair Work
Original Contract Amount $ 3,135,729.00
Current Change Order Amount $ 12,327.92 Percent: 0.393 %
Total Previous Approved Changes $ 0.00 Percent: 0.000 %
Total Change To -Date $ 12,327.92 Percent: 0.393 %
Modified Contract Amount $ 3,148,056.92
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: 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.: 005
Page: 2
AE: DCE: SCE: * DDCM:
(-LE$250K-)(-LE$750K-)(--LE$2M--)(--GT$2M--)
( 50 SS days) ( 100 SS days) ( 200 SS Days) ( GT 200 SS days)
Y / N If Y, by Date Issued
Y / N If Y , Copy to Program Budget Manager
Y / N If Y, Referred to Project Manager(PM)
Date to PM
Approval Authority Concurs with PM? Y / N If Y, Concurrence by
If N,Resolution: Approved
LPA Signatures Required?
Resolved by
Y / N If Y, Date to LPA
Date Returned
Date
FHWA Signatures Required? Y / N If Y, Date to FHWA
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer Date
Comments:
Disapproved
Date
Date Returned
Date Returned
Contract No:R -39540 INDIANA Date:09/29/2020
Change Order No:005
Contract: R -39540
Department of Transportation
Project: 1600074 - State:160007400LC4
Change Order Nbr: 005
Change Order Description: Lawn Irrigation Repair Work
Reason Code: ERRORS & OMISSIONS, Special Prov Related
Page: 3
CLN PCN PLN Item Code Unit Unit Price CO oty Comment Amount Change
0151 1600074 0151 105-06807 LS 12,327.920 1.000 C Amount:$ 12,a27.92
Item Description: ADDITIONAL
Supplemental Descriptionl: Lawn Irrigation Repairs
Supplemental Descriptlon2:
Total Value for Change Order 005 = $ 12,327.92
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
Lawn Irrigation repairs were needed due to several homeowner and church private irrigation systems being damaged because of excavation and
new construction of sidewalks and drives for the project. There was no allowance in the contract for this work and nothing was covered in the
Special Provisions. Property owners were also not compensated to repair their sprinkler lines in the property agreements for temporary
right-of-way areas.
Change Order Explanation for Specific Line Item
•f#M!i!r*iHY*#*#Y*tt**i*tf#**f!f*!1*re**t�iiiiti 4t##iY#lt+i kiff iMl+PYft+ktt#i*t*flit*fitHttfiitiHt+*itf H*t*tt*Hlttff Mi*f
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notiflcatlon and consent to this change order is hereby acknowledged.
Contractor:� �t �C— Signed By: ! ��
Date:_ 7 - 2 r - W20
lftf►Htf 11H*lfifftHt Hf+Hl+ xf+f+t#!1rf■YHttt1H#f itittitlH#Yi!!i—*fittl.t*#A Ht1H#1ti-!+f t4i....t'iHtfif►tHt —*.—
NOTE: Other requxed State and FHWA signatures will be obtained electronically through the SiteManager system.
Contract No:R -39540 INDIANA
Change Order No:005 Department of Transportation
wwrwwwwwrwwwwwwrwrwrwrrwrwwrrwrwrwwwwwwwwrrrwwwrwrwrwrwwrwrrwrwrrwrrwrwwrwrwrr«wrwwwwwwww««rrwwrrrw«wrrrrrrrrrrrrrrrwrrrrr«w
BOARD oePUBLIC WORKS APPROVpn Fnp I Or.A1 Pl IRI I('. ArFNrY
Gary A. Glot, Presidem Therese J. D.., Member
E i -bath A. Mecedik, MG.bu Jordee V. Gathers, Member
ATTEST:
01
(1
11,
Joseph A Mol—o M—be N
Linda M. Martin, Clerk
PErs -0 0
SUBMITTED FOR CONSIDERATION
Date:09/29/2020
Page: 4
November 10, 2020
(DATE)
(DATE)
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORTATION
Approval Level,.
pp Name of Approver Date Status
Project Engineer/Supervisor Patterson, Patrick 00/00/0000 Action Pending
1ETHj
IL E Y CONSTRUCTION CO., INc.
100% Quality • 100% Employee Owned • Over 100 Years
September 18, 2020
Mr. Dale Wills
Lochmueller Group
112 W Jefferson Blvd
Suite S00, South Bend, IN 46601
RE: R-39S40-A, Irrigation Work
Dear Mr. Wills
The following is the cost for the done in repairing the irrigation systems as needed on the project. Cost
include all of WISSCO's work and Rieth Riley installing Sleeves under the walk that WISSCO provided the
material for. Included with this letter is a break down of charges per property address.
Total amount requested = $12,327.92
Please let me know if you have any questions. Thank you for your consideration on this matter.
Respectfully Submitted,
11L4A&-
Jamie Plunkett
Project Manager
Rieth Riley Construction Company
25200 S. R. 23 • South Bend. IN 46614
Phone: (574) 288-8321 • www.neth-riley.com
CHANGE ORDER REQUEST FORM
ONSET DATE OF CHANGE
June 95, 2020
CHANGE ORDER TYPE
:104,Oi IF16a Work
PROPOSED COST AND TIME ADJUSTMENT
COST
COST INCREASE / (DECREASE):
$ :.22,327.92.
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:
❑ 109.03Altered C�uantitles ❑ ib9 05(a) Agreed Price ® 109 05(b) Force Account. .❑ 109.05.02 Delay Costs.:_:
PROPOSED COST CHANGE INCLUDES: ❑Labor ❑ MaCeria! fO Equipment p Lease Agreement
Subcontractor:
TIME ADJUSTMENT INCREASE / (DECREASE): (work days) N/A
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
❑ 108 08(a} Excusable;Ncn-Compensable 11.109.08(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:
® IND07/ LPA CI Contractor
DOCUMENTS AFFECTED:
❑ Contract Specifications (ref. doc name/no.)
CIldc.here to entertexL
❑ Contract Plans (ref. doc name/no.)
CHANGE ORDER AFFECTS DBE PARTICIPATION:
Click here to enter text. -
❑ yes N no (if yes, attach details)
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
[Select Date] :.
SUBMITTAL DATE OF
[Select Date]
ADDITIONAL DETAIL
ADDITIONAL DETAIL
DETAILED DESCRIPTION / JUSTIFICATION:
(include location(s), actions of contractor, owner, and other stakeholders, key events and related cause(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.)
CIPA here tgenter 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.)
Cl" here to enter.text:
SIGNATURES
Contractor:
Name: (print) Avw1
(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.
peg. 3
RIETH-RILEY CONSTRUCTION
EXTRA WORK AGREEMENT
DATE: 9/18120 WORK PERFORMED: various irrigation repairs within RAN
CONTRACT: 39540 PROJECT: 39540
FORCE ACCOUNT/EXTRA WORK FOR City of South Bend
various dates an locations. WISSCO reparied irrigation lines that were inside the R/W.
Rieth Riley placed PVC Sleeves under walks accordingly.
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
FINISHER, CRAFT FOREMAN LAPORTE
0.00
S36.59
$0.00
FINISHER, JOURNEYMAN ELKHART/8T JOE
0.00
S32.90
$0.00
FINISHER, JOURNEYMAN LAPORTE
0.00
S33.59
$0.00
FOREMAN, LABORER,ELKHART/ ST. JOSEPH
1.00
1.00
$43.20
$43.20
FOREMAN, ESOP
0.00
S44.20
$0.00
FOREMAN, FINISHER, ELKHARTIST. JOSEPH
0.00
$35.15
$0.00
FOREMAN, FINISHER, LAPORTE
0.00
$36.59
$0.00
FOREMAN, LABORER, LAPORTE
0.00
S43.20
$0.00
LABORER, ELKHART/ ST. JOSEPH
1.00
1.00
$26.10
$26.10
LABORER, LAPORTE
0.00
$31.91
$0.00
MECHANIC
0.00
$42.20
$0.00
OPERATOR, ELKHART
0.00
$31.15
$0.00
OPERATOR, LAPORTE / ST. JOSEPH
1,00
1.00
$42.20
$42.20
QA TECH
0.00
$26.10
$0.00
PROJECT SUPERINTENDENT
0.00
S50.0ol
$0.00
TEAMSTER
0.00
1 SM911
$0.00
FRINGES
TOTAL LABOR $111 .50 (2)
FICA 7.50 % x LINE (2) $8.36 (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 ELKHARTIST JOE
0,00
X
$15.60
-
$0.00
FINISHER, JOURNEYMAN LAPORTE
0,00
X
$23.14
=
$0.00
FOREMAN, LABORER,ELKHART/ ST. JOSEPH
1.00
X
36.101
$36.10
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
1.00
X
$16.38
-
$16.38
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
1.00
X
$36.101
$36.10
OA TECH
0.00
X
$1&381
$0.00
PROJECT SUPERINTENDENT
0.00
X
$12.791
$0.00
TEAMSTER
0.00
X
$16,541
$0.00
TOTAL FRINGES $88.58 (4)
WORKERS COMPENSATION 5.72 % X
LINE (2)
$6.38 (5)
BODILY INJURY / PROPERTY DAMAGE INSURANCE 5.80 % X
LINE (2)
$6.47 (6)
STATE UNEMPLOYMENT 3.85 % X
LINE (2)
$4.29 (7)
FEDERAL UNEMPLOYMENT 0.40 % X
LINE (2)
$0.45 (8)
TRAVEL ALLOWANCE OR SUBSISTENCE (NOTE #3)
$0.00 (9)
TOTAL LINES 2, 3, 4, 5, 6, 7, 8 8 9
$226.03 (10)
20 %x LINE (10)
$45.21 (11)
GRAND TOTAL LABOR LINES (10) + (11)
$271 .23 (12)
Page 1 of 2
MATERIAL 109.05 (b)(3)
Purchased or
Manufactured
Description
Quantity
Unit
Unit Price
Extenstion
$ 240.00
$
S
$
S
$
$
$
MATERIALS PURCHASED
MATERIALS MANUFACTURED
TOTAL: LINE (18) + (19)
12 % x LINE (20)
GRAND TOTAL FOR MATERIALS: LINE (20)+ (21)
EQUIPMENT 109.05 (b)(4)
$0.00 (18)
$0.00 (19)
$0.00 (20)
SO.00 (21)
$0.00 (22)
Equipment #
CONTRACTOR OWNED EQUIPMENT
FHWA HOURLY RATE
HOURS
EXTENSION
$0.00
pick up truck foreman
$25.00
1.00
$25.00
Excavator Caterpillar 308
Sw 00
1.00
$80.00
SO.00
$0.00
WOO
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
SO.00
Trucking - Striaght Time
$0.00
$0.00
Trucking - Over Time
$0.00
$0.00
Trucking - Double Time
$0.00
.0
TOTAL EQUIPMENT
$105.00
(23)
TOTAL TRUCKING
$0.00
(24)
FUEL, LUBRICANTS AND TRANSPORTATION COSTS
$0.00
(25)
TOTAL LINES (23) + (24) + (25)
$105.00
(26)
12 % x LINE (26)
$12.60
(27)
GRAND TOTAL FOR EQUIPMENT: LINES (26) + (27)
$117.60
(28)
SUBCONTRACTORS 109.05 (b)(6)
DESCRIPTION AMOUNT
WISSCO Irrigation , Inc. $11,020.28
TOTAL SUBCONTRACT WEEK ENDING $11,020.28 (29)
7% $771.42 (31)
(32)
GRAND TOTAL FOR SUBCONTRACTORS: LINES (30) + (31) + (32) $11 ,791.70 (33)
TOTAL OF WORK COMPLETED FOR THE WEEK
TOTAL LINES (12), (17), (22), (28) & (33) $12,180.53 (34)
1.1 % OF BOND RATE BASED UPON LINE (34) $133.99 (35)
10 % x LINE (35) $13.40 (36)
TOTAL EXTRA WORK LINES: (34) + (35) + (36) $12,327.92 (37)
Page 2 of 2
WISSCO Irrigation, In:C.
Invisible Fence of South Bend
1820 South Bend Ave.
South Bend, IN 46637
USA
Voice: 574-277-9861
Fax: 574-277-9860
ArrA11�v��,
BiII TO.'
Rieth Riley
25200 State Rd. 23
South Band, IN 46614
INVOICE
Invoice Number: GS-IRONWOODCORBY
I nvo ice Date: 8121120
Page: 1
Duplicate
0`{ 1 o
Customer ID: IRONWOODDRCOR
:: , Customer PO',
Payment teffhs .
bales i#ep m
tJue > .ate
`
Net 10 Days
8/31120
Description
Amount
300 ft - 4" PVP Pipe for sleeves - dropped off for contractor
771.00
Er1. nwoo
-
Material
1,703.55
Labor
3,076.50
81"t^ .. nwood
Material
622.75
Labor
446.00
VK,9 , rol , W, 1W'S
Material
557.08
Labor
1,293.00
, � C66
Material
1,319.25
Labor
987.00
--- -- ----- ---
I
-------------- ------
Check/CradIt Memo Nt i
• I�
ti
i
Subtotal
Sales Tax
Total Invoice Amount
PaymentlCred it Appiled
TOTAL
Overdue invoices are subject to late charges.
10,678.13
341.15
11,020.26
•11,t)20:28
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 10/15/2020
Name Leslie Biek Department PW
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 ADDronriate Item Tvne —
Professional Services Agreement
❑ Open Market Contract
❑ Bid Opening
❑ Quote Opening
❑ Proposal Opening
® Chg. Order, No. 4 & 5
n Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
All Submissions
U Contract U Proposal
❑ Amendment/Addendum ❑ Special Purchase, QPA
❑ Bid Award ❑ Req. to Advertise
❑ Quote Award ❑ Reject Bids/Quotes
❑ C/O & PCA No. ❑ PCA
❑ Traffic Control ❑ Resolution
n Ease./Encroach
Information
INDOT- (Rieth Rilev Contractor
❑ Title
Sheet
U Yes U If Yes, Approved by Purchasing
® No
MBE
❑ WBE Completed E-Verify Form Attached ❑ Yes
No
Corby Ironwood Rockne Intersection Improvement
116-034
LR&S Streets and Alleys
442001
$13,920.77
Unit Price
Purpose/Description CO #4 is for an additional $1,592.85 to change the signal head visor on
Rockne after it was installed and to remove the banner arms from the
streetlights after instillation. CO#5 is for an additional $12,327.92 to
repair irrigation lines that were dama ed during construction.
For Change Orders Only
Amount of ® Increase $ 13,920.77
❑ Decrease ($ )
Previous Amount $ 3,162,661.70
Increase 0.44%
Current Percent of Change: Decrease ( %)
New Amount $ 3,176,582.47
Increase 1.30%
Total Percent of Change: Decrease ( %)
Time Extension Amount:
New Completion Date: