HomeMy WebLinkAboutChange Order No 2 - Brick Pavement Spot Repair Proj No. 121-019 - Acorn Landscaping 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 26, 2021
Ms. Rebecca Matthys
Acorn Landscaping & Excavation LLC
3680 W. Sample St.
South Bend, IN 46619
rebecca.matthys03@gmail.com
RE: Change Order No. 1 – Brick Pavement Spot Repair – Project No. 121-019
Dear Ms. Matthys:
At its October 26, 2021 meeting, the Board of Public Works approved the above
referenced Change Order for an increase of $26,627, bringing the revised contract amount to
$161,321.
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 26, 2021
City of South Bend
Department of Administration & Finance
Change Order Request Form
Multiple PO lines:
Project POs:
PO Number PO-0010848
Line Number 1
Original Dollar Amount $134,694.00
New Dollar Amount
(For liquidation request, enter $0)$161,321.00
Reason Code (if changed)
Financial Dimensions (fund-dept-
division-subdivision-main account)455-06-600-506-442001
Project Code (if applicable)PROJ00000283
Description of change (include
budget impact)
Increase of $26,627.00 (+19.77%) to cover necessary additional brick pavement spot
repairs within the predetermined project limits.
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)Ron O'Connor 10-14-2021
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.
PO-10848 PO Change Order Request Form increase 26627.00 Leslie - ro 1 of 3