HomeMy WebLinkAboutChange Order No 1 & PCA - Former Salvation Army Building HVAC Repairs Proj No. 119-084C - Edward J. White, Inc.
ELIZABETH A. MARADIK GARY A. GILOT JORDAN V. GATHERS JOSEPH R. MOLNAR MURRAY L. MILLER
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
May 20, 2021
Mr. Jeff Bucher, Jr.
Edward J. White, Inc.
1011 S. Michigan St.
South Bend, IN 46601
jbucher@ejwhiteinc.net
RE: Change Order No. 1 (Final)/Project Completion Affidavit
Former Salvation Army Building HVAC Repairs – Project No. 119-084C
Dear Mr. Bucher:
It has come to my attention that a signature was included in error on your documentation
from the May 11, 2021 Board of Public Works meeting. I have updated the attached
documentation to remove Board Member Jordan Gather’s signature. Mr. Gathers was not present
at the time this item was voted on; therefore, his signature should not have been included.
I apologize for this administrative oversight. Please update your records accordingly and
feel free to call me with any questions at (574) 235-9251.
Sincerely,
/s/ Anne Fuchs
Anne Fuchs, Clerk
Enclosures
AF/lh
ELIZABETH A. MARADIK GARY A. GILOT JORDAN V. GATHERS JOSEPH R. MOLNAR MURRAY L. MILLER
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
May 11, 2021
Mr. Jeff Bucher, Jr.
Edward J. White, Inc.
1011 S. Michigan St.
South Bend, IN 46601
jbucher@ejwhiteinc.net
RE: Change Order No. 1 (Final)/Project Completion Affidavit
Former Salvation Army Building HVAC Repairs – Project No. 119-084C
Dear Mr. Bucher:
At its May 11, 2021 meeting, the Board of Public Works approved the Final Change
Order for this project, for a decrease of $3,753.89. The final contract amount is $38,696.11.
In addition, the Project Completion Affidavit for this project was approved in the amount
of $38,696.11. 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
[Final]
May 11, 2021
May 11, 2021
City of South Bend
Department of Administration & Finance
Change Order Request Form
Multiple PO lines:
PO Number PO-0007778
Line Number 1
Original Dollar Amount $42,450.00
New Dollar Amount
(For liquidation request, enter $0)$0.00
Reason Code (if changed)PW-RQ
Financial Dimensions (fund-dept-
division-subdivision-main account)324-10-102-121-443001--
Project Code (if applicable)PROJ00000073
Description of change (include
budget impact)PO can be liquidated - final change order decreases amount.
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)
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 two lines on the same PO, fill out a separate section for each line affected by the change
order.
Supplement 508 Form - Change Order Request Form 1 of 5
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 04/30/2021
Name Zach Hurst Department DPW
BPW Date 05/11/2021 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 Edward J. White, Inc.
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Former Salvation Army Building HVAC Repairs
Project Number 119-084C
Funding Source River West DA TIF
Account No. PR-00007113
Amount $38,696.11 [Final]
Terms of Contract
Purpose/Description Change order is a deduction to account for unused allowance. Close-out
documentation also included.
For Change Orders Only
Amount of Increase
Decrease
$
($ 3,753.89)
Previous Amount $ 42,450.00
Current Percent of Change:
Increase
Decrease
%
(-8.8%)
New Amount $ 38,696.11
Total Percent of Change:
Increase
Decrease
%
(-8.8%)
Time Extension Amount:
New Completion Date: