HomeMy WebLinkAboutChange Order No 1 - 2020 Curb and Sidewalk Additional Proj No. 120-001A - TX Concrete, LLC
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
October 12, 2021
Mr. Jose L. Quijada
TX Concrete, LLC
24899 Fillmore Rd.
South Bend, IN 46619
quijadas1@sbcglobal.net
RE: Change Order No. 1 – 2020 Curb and Sidewalk Additional – Project No. 120-001A
Dear Mr. Quijada:
At its October 12, 2021 meeting, the Board of Public Works approved the above
referenced Change Order for an increase of in an amount not to exceed $13,007.50 and an
additional forty-five (45) days, bringing the revised contract amount to $81,805 with a new
completion date of July 12, 2021.
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
October 12, 2021
City of South Bend
Department of Administration & Finance
Change Order Request Form
Multiple PO lines:
Project POs:
PO Number PO-0006102
Line Number 1
Original Dollar Amount $68,797.50
New Dollar Amount
(For liquidation request, enter $0)$81,805.00
Reason Code (if changed)
Financial Dimensions (fund-dept-
division-subdivision-main account)202-06-602-505-431000
Project Code (if applicable)
Description of change (include
budget impact)Addition of 18.91% for additional work due to unforeseen conditions.
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.
Supplement 508 Form - 120-001A CO1 1 of 3