HomeMy WebLinkAboutChange Order No 1 - 2021 Tree and Stump Removal Proj No. 121-002 - K & R Tree & Stump Service 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. Kevin J. Kenney
K & R Tree Service LLC
1724 S. Grant St.
South Bend, IN 46613
treecutterkey@yahoo.com
RE: Change Order No. 1 – 2021 Tree & Stump Removal – Project No. 121-002
Dear Mr. Kenney:
At its October 12, 2021 meeting, the Board of Public Works approved the above
referenced Change Order for an increase of $4,178 and an additional thirty (30) days, bringing
the revised contract amount not to exceed $29,276, with a new completion date of August 29,
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
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:
(Signature) (Date) Engineering Project Manager (Print Name)
Finnian Cavanaugh 9/30/21
PO-0010119
10/12/21
October 12, 2021
City of South Bend
Department of Administration & Finance
Change Order Request Form
Multiple PO lines:
Project POs:
PO Number PO-0010119
Line Number 1
Original Dollar Amount $25,098.00
New Dollar Amount
(For liquidation request, enter $0)$29,276.00
Reason Code (if changed)
Financial Dimensions (fund-dept-
division-subdivision-main account)202-06-602-505-431000
Project Code (if applicable)PROJ00000280
Description of change (include
budget impact)Addition of $4,178.00 to cover additional tree removals
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)Ron O'Connor 9/30/2021
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.
2021 09 September 30 PO-10119 K and R Tree Change Order Request Form 4178 1 of 3
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: September 30, 2021
Name: Finnian Cavanaugh Department of Public Works – Engineering Division
BPW Date: October 12, 2021
Phone Extension: 5961 or
fcavanau@southbendin.gov
Required Prior to Submittal to Board
BPW Attorney X 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 K&R Tree Service LLC
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Tree and Stump Removal 2021
Project Number 121-002
Funding Source Motor Vehicle Highway
Account No. PO-0010119 (202-06-602-505-431000--PROJ00000280)
Amount $29,276 new amount
Terms of Contract NTE
Purpose/Description Additional tree removals
For Change Orders Only
Amount of Increase
Decrease
$4,178.00
($ )
Previous Amount $ 25,098.00
Current Percent of Change:
Increase
Decrease
16.65%
( %)
New Amount $ 29,276.00
Total Percent of Change:
Increase
Decrease
16.65%
( %)
Time Extension Amount: 30 days
New Completion Date: 8/29/21