HomeMy WebLinkAboutChange Order No 1 & PCA - Burke Building Roof Repairs Proj No. 119-084A - BSR Roofmasters
ELIZABETH A. MARADIK GARY A. GILOT JORDAN V. GATHERS JOSEPH R. MOLNAR
1316 COUNTY-CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/ 235-9251
FAX 574/ 235-9171
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
January 12, 2021
Ms. Dolores Ullery
BSR Roofmasters
730 W. Indiana Ave.
South Bend, IN 46613
bsr.roofmasters@att.net
RE: Change Order No. 1 (Final)/Project Completion Affidavit
Burke Building Roof Repairs – Project No. 119-084A
Dear Ms. Ullery:
At its January 12, 2021 meeting, the Board of Public Works approved the Final Change
Order for this project, for a decrease of $480.00. The final contract amount is $6,770.
In addition, the Project Completion Affidavit for this project was approved in the amount
of $6,770. 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/ Anne Fuchs
Anne Fuchs, Clerk
Enclosures
AF/lh
January 12, 2021
01/05/2021
January 12, 2021
DEPARTMENT OF PUBLIC WORKS
DIVISION OF ENGINEERING
Project Number: _______________ Project Name: __________________________ Change Order #: ____
DATE INITIATED:BPW DATE:
Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.).
Attachments: (List documents support change required)
Amount of Increase / Decrease: $____________________
Categories (Pick One):
Scope of Work
Differing Site Conditions, Changed Conditions
Conflicted Specifications and Drawings
Failed Materials
Error
Omission
Final Quantity Adjustment
_______________________
Previously approved Change Order(s): $___________________
Current Percent of Change: ____________________ %
New Total Amount: $____________________
Total Percent of Change: ____________________ %
Funding Secured From: __________________________
(filled out by PM)
RECOMMENDED BY:
Project Inspector (Print Name)(Signature)(Date)
REVIEWED BY:
Construction Manager (Print Name)(Signature)(Date)
APPROVED BY:
Engineering Project Manager (Print Name)(Signature)(Date)
APPROVED BY:
City Engineer (Print Name)(Signature)(Date)
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 01/05/2021
Name Zach Hurst Department DPW
BPW Date 01/12/2021 Phone Extension 3057
Review and Approval Required Prior to Submittal to Board
Diversity Compliance
and Inclusion Officer Officer Name
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. 1 PCA
Chg. Order, No. Traffic Control Resolution
Other: Ease./Encroach
Required Information
Company or Vendor Name BSR Roofmasters
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Burke Building Roof Repairs
Project Number 119-084A
Funding Source DCI Cumulative Capital Improvement
Account No.PO-0004343
Amount $480.00 C.O., $6,770.00 Final Amt.
Terms of Contract Lump Sum
Purpose/Description Final C.O. to balance quantities, along with Project Completion Affidavit and
Waiver of Lien.
For Change Orders Only
Amount of Increase
Decrease
$
($ 480.00)
Previous Amount $ 7,250.00
Current Percent of Change:
Increase
Decrease
%
(6.6%)
New Amount $ 6,770.00
Total Percent of Change:
Increase
Decrease
%
(6.6%)
Time Extension Amount:
New Completion Date: