HomeMy WebLinkAboutChange Order No 1 - Edison Well #4 Refurbishment – Well Cleaning Proj No. 120-060 - Peerless Midwest, Inc.
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
March 9, 2021
Mr. Frank Williams
Peerless Midwest, Inc.
55860 Russell Industrial Pkwy.
Mishawaka, IN 46545
francis.williams@suez.com
RE: Change Order No. 1 – Edison Well #4 Refurbishment – Well Cleaning
Project No. 120-060
Dear Mr. Williams:
At its March 9, 2021 meeting, the Board of Public Works approved the above referenced
Change Order for an increase of $9,617, bringing the revised contract amount to $81,017.
Enclosed is a copy of the Change Order 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
March 9, 2021
City of South Bend
Department of Administration & Finance
Change Order Request Form
Multiple PO lines:
Project POs:
PO Number 6095
Line Number 1
Original Dollar Amount $71,400.00
New Dollar Amount
(For liquidation request, enter $0)$81,017.00
Reason Code (if changed)
Financial Dimensions (fund-dept-
division-subdivision-main account)Water Works O&M, 620-06-604-602-436005
Project Code (if applicable)
Description of change (include
budget impact)Additonal rehabiltation components and electrical modifications.
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)(PAT member's name and date to be completed by PAT member)
PO Number
Line Number
Original Dollar Amount
New Dollar Amount
(For liquidation request, enter $0)
Reason Code (if changed)
Financial Dimensions (fund-dept-
division-subdivision-main account)
Project Code (if applicable)
Description of change (include
budget impact)
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)(PAT member's name and date to be completed by PAT member)
PO Number
Line Number
Original Dollar Amount
Changing the line amount:
You can only change a line amount if it has NOT been invoiced against.
• If the line has NOT been invoiced – reduce the line amount to equal what it should be.
• If the line has been invoiced – cancel the delivery remainder and finalize the individual line, then add a new line for the
amount that should be remaining.
If you have changes to more than one line on the same PO, fill out a separate section for each line affected by the change
order.
For change orders on project-related POs, this form must be approved by the Project Accounting Team as described in
Supplement 508.
PO # 6095 CHANGE REQUEST 1 of 3
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 02/25/2021
Name Becca Plantz Department Public Works
BPW Date 03/09/2021 Phone Extension 5998
Review and Approval Required Prior to Submittal to Board
Diversity Compliance
and Inclusion Officer Officer Name Michael Patton
BPW Attorney Attorney Name Clara McDaniels
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. _PCA
Chg. Order, No. 1 Traffic Control Resolution
Other: Ease./Encroach
Required Information
Company or Vendor Name Peerless Midwest, Inc.
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Edison Well #4 Refurbishment – Well Cleaning
Project Number 120-060
Funding Source Services & Charges-Repairs & Maint-Other Equip R&M
Account No.PR-00005227
Amount
Terms of Contract Lump Sum
Purpose/Description Inspect, clean, and rehab Well #4 at Edison Filtration Plant.
For Change Orders Only
Amount of Increase
Decrease
$ 9,617.00
($ )
Previous Amount $ 71,400.00
Current Percent of Change:
Increase
Decrease
13.47%
(%)
New Amount $ 81,017.00
Total Percent of Change:
Increase
Decrease
13.47%
(%)
Time Extension Amount:
New Completion Date: