HomeMy WebLinkAboutChange Order Nos 4-7 & 9-15 - Coal Line Trail Proj No. 115-063 - INDOT & Selge Construction
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS 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
July 12, 2022
Mr. Robert Kuhns
Selge Construction Co., Inc.
2833 South 11TH St.
Niles, MI 49120
aswinehart@selgeconstruction.com
RE: Change Order Nos. 4-7 and 9-15 – Coal Line Trail, Phase I – (DES#1401810)
Project No. 115-063
Dear Mr. Kuhns:
At its July 12, 2022 meeting, the Board of Public Works approved the above referenced
Change Orders to be increased by $68,665.95, bringing the revised contract amount to
$68,665.95 with a new total contract amount of $1,871,262.80 and the amount to be paid by the
City in an amount not to exceed $29,921.77.
Enclosed is a copy of the Change Order for your records.
If you have any further questions, please call this office at (574) 235-9251.
Sincerely,
/s/ Theresa Heffner
Theresa Heffner, Clerk
Enclosures
TH/lh
INTER-OFFICE MEMORANDUM
DEPARTMENT OF PUBLIC WORKS
DIVISION OF ENGINEERING
TO: Theresa Heffner, Clerk, Board of Public Works
FROM: Finn Cavanaugh, Project Engineer
SUBJECT: Project No. 115-063 Coal Line Trail – Phase I
Change Orders 4-7,9-15
DATE: July 1, 2022
Attached are Change Orders 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, and 15 for the Coal Line Trail Phase
I project, INDOT DES#1401810.
Change Order 4
Due to a design error, an outdated and incorrect special provision for the shade structures was
included in the bid specifications. This was corrected after fabrication had begun, thus additional
material and labor costs were required. This change results in an addition of $4,558.40 and is a
participating item, meaning the City would pay 20% of this cost, $911.68.
Change Order 5
In 2021 additional design work was done to revise the trail alignment to match with the original
railroad, since at the time of original design the City had not acquired the full width of right-of-
way. This design change necessitated an update to the Stormwater Quality Control Plan. Since
the change of alignment was not part of the original contract, this change is non-participating
and the cost to the City is $1,712.00.
Change Order 6
Michiana Area Council of Governments (MACOG) as the MPO for this project, requested that
pedestrian traffic counter loops be added to the project. These are also a participating line item
with an overall additional cost of $2,810.70. The City’s 20% share of this cost is $562.14.
Change Order 7
Due to the aforementioned change in alignment, the tree clearing subcontractor was required to
stop work for a 4-month period, and resume clearing at a later time. As such the subcontractor
incurred remobilization costs that the City is responsible for. This is a non-participating item and
the cost to the City is $4,066.00.
Change Order 9
This change order is for additional cost to replace traffic detector loops damage during milling of
Wilber Street at the intersection of the Trail and Lincoln Way West. This is a participating line
item with a total additional cost of $2,406.85. The City’s 20% share of this cost is $481.37.
Change Order 10
Due to the aforementioned change in alignment, the contractor was required to do additional
construction engineering to adjust to the new alignment. Since this change in alignment was not
part of the original contract the change is non-participating and the cost to the City is $6,577.83.
Change Order 11
Due to design error, the plans for inlet structures at the intersection of the Trail and Woodward
Avenue called for incorrect castings that would not be flush with the pavement and curb. This
change order is to replace the designed Type 7 “beehive” castings with Type 10 “curb box”
castings. The change order is participating with a total cost of $2,006.26. The City’s 20% share
of this is $401.25.
Change Order 12
Due to design error, the fence between the trail and the parking lot of the Portage Plaza strip
mall was directed to be removed but not replaced. The City deemed it a necessary safety
measure to replace the fence, deterring vehicle traffic from entering the trail from the parking lot.
The work is necessary for safety and is deemed participating, with a total cost of $14,178.00.
The City’s 20% share of this is $2,835.60.
Change Order 13
Due to design error, a 32” gap between the stairs and bridge structure at Portage Avenue was
instructed to be filled with topsoil and seeding, which would be very difficult to maintain. The City
and INDOT agreed to a proposed solution from the contractor that would fill the gap with
decorative boulders held in place by a 5” layer of concrete, which would provide an aesthetic but
non-attention grabbing infill at the stairs. The change order was not deemed part of the original
scope of work by INDOT and is non-participating. The cost to the City is $7,879.90.
Change Order 14
Due to design error, there was no item for HMA patching in the contract. HMA Patching was
necessary along the boundary between the trail and the Portage Plaza parking lot, as well as
around the raised crossing at Woodward Avenue. Since this work was necessary to complete
the scope of the contract, this change is participating with a total cost of $22,470.00. The City’s
20% share of this is $4,494.00.
Change Order 15
Change Orders 1, 2, and 3 were processed and approved by the Board of Public Works on
November 23rd, 2021, in the total amount of $178,895.51. These change orders covered,
respectively, a change of trail material from HMA to Concrete, change of service point type, and
change to color temperature of luminaires along the trail. Per direction of the INDOT Area
Engineer, the intention was for the City to pay 100% of the increase in cost for each new line
item. However, the new (non-participating) items needed a separate purchase order to be paid
for according to the correct cost-share. This change order corrects the amounts of cost share
between the City and INDOT. This change order does not create a net change to the project
and does not result in additional charge to the City.
The total increase to the overall project cost for the above change orders is $68,665.95 (4.2%).
The total additional cost to the City from these items is $29,921.77. The costs for all items have
been found to be within typical unit prices for similar work and are thus recommended by
Engineering.
This project is being funded out of the TIF River West Development fund, with DFO project code
PROJ-00000018. Engineering requests the Board of Public Works approve the change orders
subject to financial approvals. Engineering has submitted the funding request in PR-00017412.
The INDOT Change Order Summaries for all pertinent change orders are attached. If you have
any questions, please respond.
July 12, 2022
Contract No:R -38064 Change Order No.: 005
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 005 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: SCOPE CHANGES, Added Quantities/Items
Description: Storm Water Quality Control Plan Revisions
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 1,712.00 Percent: 0.105 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 180,607.51 Percent: 11.123 %
Modified Contract Amount $ 1,804,308.85
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 005
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:005 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 005
Change Order Description: Storm Water Quality Control Plan Revisions
Reason Code:SCOPE CHANGES, Added Quantities/Items
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0134 1401810 0133 205-12618 LS 1,712.000 1.000 C Amount:$ 1,712.00
Item Description:SWQCP PREPARATION
Supplemental Description1: Additional
Supplemental Description2:
Total Value for Change Order 005 = $ 1,712.00
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
The Stormwater Quality Control Plan was completed for the original trail alignment. The original trail alignment was shifted approximately 25 feet
to the south to align with the railroad roadbed. This was due to the design was completed before the City of South Bend had acquired all the
railroad right of way. When design was completed, the City only owned the north half of the right of way. Once clearing began the City desired to
have the trail follow the center of the right of way on old railroad roadbed. This required revising the alignment from approximately Station 15.00
to 38.00. The SWQCP was revised in this area to account for the shift in the alignment. This change order is for the costs of revising the
SWQCP. The contractors request for change order is attached to this change order. A cost analysis was not performed; however, the revised
cost is in comparison with the original cost for the total contract and the percentage of trail that was realigned and deemed acceptable. This work
is not in the original scope of the contract and therefore deemed non participating. The AE and PM have been notified and their notification,
concurrence emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
6/28/22
Robert P. Kuhns, P.E.
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:005 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
July 12, 2022
Contract No:R -38064 Change Order No.: 007
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 007 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: SCOPE CHANGES, Work Outside Const Limits
Description: KC Tree Additional Mobilization and Tree Removal
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 4,066.00 Percent: 0.250 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 182,961.51 Percent: 11.268 %
Modified Contract Amount $ 1,806,662.85
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 007
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:007 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 007
Change Order Description: KC Tree Additional Mobilization and Tree Removal
Reason Code:SCOPE CHANGES, Work Outside Const Limits
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0136 1401810 0135 201-52370 LS 4,066.000 1.000 C Amount:$ 4,066.00
Item Description:CLEARING RIGHT OF WAY
Supplemental Description1: Additional
Supplemental Description2:
Total Value for Change Order 007 = $ 4,066.00
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
The subcontractor began clearing right of way for the original trail alignment. Shortly after beginning clearing, they were instructed to stop as the
alignment of the trail was going to move after the City of South Bend realized they owned all the right of way and could move the trail to the old
railroad roadbed, which was much more desirable. After 4 months of redesign and environmental review work resumed on clearing the right of
way. This change order is for the costs for the subcontractor to remobilize to the site and for two trees that were removed outside of the
construction limits at the request of the city. The contractors request for change order is attached to this change order. A cost analysis was not
performed; however, the costs agree with the original cost of clearing right of way for the contract and deemed acceptable. This work is not
necessary to complete the original scope of the contract and therefore deemed non participating. The AE and PM have been notified and their
notification, concurrence emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
6/28/22
Robert P. Kuhns, P.E.
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:007 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
July 12, 2022
Contract No:R -38064 Change Order No.: 010
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 010 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: SCOPE CHANGES, Added Quantities/Items
Description: Additional Construction Engineering
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 6,577.83 Percent: 0.405 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 185,473.34 Percent: 11.423 %
Modified Contract Amount $ 1,809,174.68
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 010
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:010 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 010
Change Order Description: Additional Construction Engineering
Reason Code:SCOPE CHANGES, Added Quantities/Items
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0138 1401810 0137 105-06845 LS 6,577.830 1.000 C Amount:$ 6,577.83
Item Description:CONSTRUCTION ENGINEERING
Supplemental Description1: Additionall
Supplemental Description2:
Total Value for Change Order 010 = $ 6,577.83
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
The subcontractor completed construction engineering of the original trail alignment prior to the decision to realign the trail as explained in
change order 5. This change order is for the cost to complete construction engineering of the new trail alignment between approximately Station
15.00 to 38.00. The contractors request for change order is attached to this change order. A cost analysis was not performed; however, the cost
compares with the original contract price and the percentage of work completed and deemed acceptable. The work is not necessary to complete
the original scope of the contract and therefore deemed non participating. The AE and PM have been notified and their notification, concurrence
emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
6/28/22
Robert P. Kuhns, P.E.
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:010 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
Contract No:R -38064 Change Order No.: 011
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 011 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: ERRORS & OMISSIONS, Design/Plan Related
Description: Provide Type 10 Casting to Replace Type 7 Casting
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 2,006.26 Percent: 0.124 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 180,901.77 Percent: 11.142 %
Modified Contract Amount $ 1,804,603.11
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 011
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:011 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 011
Change Order Description: Provide Type 10 Casting to Replace Type 7 Casting
Reason Code:ERRORS & OMISSIONS, Design/Plan Related
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0139 1401810 0138 720-44055 EACH 1,003.130 2.000 C Amount:$ 2,006.26
Item Description:CASTING 10 FURNISH AND ADJUST TO GRADE
Supplemental Description1: Replace F7
Supplemental Description2:
Total Value for Change Order 011 = $ 2,006.26
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
The casting for Structures 209 and 210 called for type 7 castings. These casting are in the pavement on Woodward Avenue. The castings being
a beehive shape do not work as snowplows would hit them and most likely dislodge them. They also are not bicycle safe and would not provide
proper drainage along the curb line. This change order is to replace the type 7 castings with type 10 castings with curb backs and bicycle safe
grates. The contractors request for change order is attached to this change order. A cost analysis was performed and is outside the average unit
price for this item. However it is below the average unit price and deemed acceptable. This work is necessary to complete the original scope of
the contract and is therefore deemed participating. The AE and PM have been notified and their notification, concurrence emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
Robert P. Kuhns, P.E.
6/28/22
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:011 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
Contract No:R -38064 Change Order No.: 012
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 012 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: ERRORS & OMISSIONS, Design/Plan Related
Description: 6 Foot Chain Link Fence
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 14,178.00 Percent: 0.873 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 193,073.51 Percent: 11.891 %
Modified Contract Amount $ 1,816,774.85
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 012
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:012 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 012
Change Order Description: 6 Foot Chain Link Fence
Reason Code:ERRORS & OMISSIONS, Design/Plan Related
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0140 1401810 0139 603-92636 LFT 47.260 300.000 C Amount:$ 14,178.00
Item Description:FENCE CHAIN LINK 72 IN
Supplemental Description1:
Supplemental Description2:
Total Value for Change Order 012 = $ 14,178.00
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
The contract called to remove the existing chain link fence between the new trail construction and the parking lot at Portage Plaza. It did call to
replace this fence. After the trail was constructed, it was determined that the fence should be replaced to keep pedestrians and vehicles from
accessing the trail from the parking lot. It will also deter a vehicle from crossing the trail and heading down a steep embankment providing a level
of safety. The contractors request for change order is attached to this change order. A cost analysis was performed, and the unit price was found
to be inside the average unit price for this item and deemed acceptable. The work is necessary to complete the original scope of the contract and
also provides additional safety measures and is there for deemed participating. The AE and PM have been notified and their notification,
concurrence emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
Robert P. Kuhns, P.E.
6/28/22
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:012 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
Contract No:R -38064 Change Order No.: 013
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 013 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: SCOPE CHANGES, Project Upgrades
Description: Concrete Staiway Infill
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 7,879.90 Percent: 0.485 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 186,775.41 Percent: 11.503 %
Modified Contract Amount $ 1,810,476.75
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 013
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:013 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 013
Change Order Description: Concrete Staiway Infill
Reason Code:SCOPE CHANGES, Project Upgrades
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0141 1401810 0140 616-12161 SYS 60.290 130.700 C Amount:$ 7,879.90
Item Description:RIPRAP GROUTED 6-9 IN
Supplemental Description1:
Supplemental Description2:
Total Value for Change Order 013 = $ 7,879.90
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
Concrete stairs were constructed as part of this contract along side of the existing Portage Road bride. A gap between the stairs and the bridge
32 inches wide did not make sense to topsoil and seed as it would be difficult to maintain as it is behind stair railing. The proposed solution from
the contractor to place 5 inches of concrete in the space depress decorative boulders into fresh concrete providing no need to maintain. It would
also deter pedestrians from using this space. The City of South Bend agreed with this proposal. The contractors change order request form is
attached to this change order. A cost analysis was performed using the closest item to this installation. The was not enough data to complete the
analysis, however the contractors unit price was lower that all listed. They have also included costs for labor, materials, and equipment and have
been deemed acceptable. The cost analysis data is attached to this change order. The work is not necessary to complete the original scope of
the contract and therefore deemed nonparticipating. The AE and PM have been notified and their notification, concurrence emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
6/28/22
Robert P. Kuhns, P. E.
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:013 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
Contract No:R -38064 Change Order No.: 014
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 014 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: ERRORS & OMISSIONS, Design/Plan Related
Description: HNA Patching
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 22,470.00 Percent: 1.384 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 201,365.51 Percent: 12.402 %
Modified Contract Amount $ 1,825,066.85
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 014
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:014 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 014
Change Order Description: HNA Patching
Reason Code:ERRORS & OMISSIONS, Design/Plan Related
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0142 1401810 0141 304-07490 TON 401.250 56.000 C Amount:$ 22,470.00
Item Description:HMA PATCHING TYPE B
Supplemental Description1:
Supplemental Description2:
Total Value for Change Order 014 = $ 22,470.00
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
There was no pay item for HMA patching in the contract. HMA patching was necessary along the edge of the Portage Plaza parking lot after
constructing the trail and on Woodward Avenue after construction of the pedestrian crossing and install storm sewer across Woodward Avenue.
The contractors change order request form is attached to this change order. A cost analysis was performed, and the cost was found to be within
the average unit price for this item and deemed acceptable. The work is necessary to complete the original scope of the contract and therefore
deemed participating. The AE and PM have been notified and their notification, concurrence emails are attached.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Robert P. Kuhns, P.E.
Selge Construction Co., Inc.
6/28/22
Contract No:R -38064 INDIANA Date:06/27/2022
Change Order No:014 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
Contract No:R -38064 Change Order No.: 015
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -38064 Letting Date:03/10/2021
District:LAPORTE DISTRICT AE:Hauersperger, Steven PE/S:Riemke, Ric Status:Draft
Change Order Information Change Order No.: 015 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: FINAL QUANTITY ADJUSTMENT
Description: Concrete Sidewalk Participating and Non Participating
Original Contract Amount $ 1,623,701.34
Current Change Order Amount $ 0.00 Percent: 0.000 %
Total Previous Approved Changes $ 178,895.51 Percent: 11.018 %
Total Change To-Date $ 178,895.51 Percent: 11.018 %
Modified Contract Amount $ 1,802,596.85
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value $ 0.00
Previous Time Approved SS Days by AE:______ DCE:______ SCE:______ DDCM:______
SS Days____________ SP Days Value $ _______________
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R -38064 Change Order No.: 015
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______*
($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- )
(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days)
Verbal Approval Required?Y / N If Y, by_____________ Date Issued___________
Total Change To-Date>5%?Y / N If Y , Copy to Program Budget Manager_________________
Scope/Design Recommendation
Required?
Y / N If Y, Referred to Project Manager(PM) __________________
Date to PM__________ Date Returned___________
Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________
If N,Resolution: Approved __________ Disapproved ___________
Resolved by_________________________ Date__________
LPA Signatures Required?Y / N If Y, Date to LPA _____________ Date Returned _________
FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer _________________________Date _____________
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contract No:R -38064 INDIANA Date:06/28/2022
Change Order No:015 Department of Transportation Page: 3
Contract:R -38064
Project:1401810 - State:140181000LC4
Change Order Nbr: 015
Change Order Description: Concrete Sidewalk Participating and Non Participating
Reason Code:FINAL QUANTITY ADJUSTMENT
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0130 1401810 0128 604-06070 SYS 41.500 -3207.663 C Amount:$ -133,118.01
Item Description:SIDEWALK CONCRETE
Supplemental Description1:
Supplemental Description2:
0143 1401810 0142 604-06070 SYS 41.500 3207.663 C Amount:$ 133,118.01
Item Description:SIDEWALK CONCRETE
Supplemental Description1:
Supplemental Description2:
Total Value for Change Order 015 = $ 0.00
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
Change Orders 1, 2 and 3 created new non participating items which replaced participation items that were reduced to zero. The non
participating items needed their own purchase order in order for payment to be made on those items. Once the dollar amount of change order 1
exceeded the dollar amount of the new non participating purchase order additional funds were requested to pay for PLN 0128. This was in error
as the total dollar amount of the non participating purchase order should have been the net total of the three change orders which it is and the
second non participating purchase order should not have been requested. This change order reduces the amount of the non participating item
PLN 0128 and creates a new item for the amount of the portion of that item that should have been participating. This change order does not
increase the cost of the contract, it just puts the dollar amounts into the purchase orders where they belong.
Change Order Explanation for Specific Line Item
****************************************************************************************************************************
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor:____________________________________________Signed By:_____________________________________________
Date:__________________________________________________
***************************************************************************************************************************
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Selge Construction Co., Inc.
6/29/22
Robert P. Kuhns, P.E.
Contract No:R -38064 INDIANA Date:06/28/2022
Change Order No:015 Department of Transportation Page: 4
****************************************************************************************************************************
APPROVED FOR LOCAL PUBLIC AGENCY
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
______________________________________________________________________________
(SIGNATURE)(TITLE)(DATE)
****************************************************************************************************************************
SUBMITTED FOR CONSIDERATION
PE/S _________________________
****************************************************************************************************************************
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
July 12, 2022
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: July 1st, 2022
Name: Finnian Cavanaugh Department of Public Works – Engineering Division
BPW Date: July 12th, 2022 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. 4-7,9-15 Traffic Control Resolution
Other: Ease./Encroach
Required Information
Company or Vendor Name Indiana Department of Transportation (INDOT)
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name Coal Line Trail Phase I (CN)
Project Number 115-063
Funding Source TIF River West Development
Account No. 324-10-102-121-444000--PROJ00000018
Amount $29,921.77 to be paid by City
Terms of Contract NTE
Purpose/Description Change orders for construction of Coal Line Trail Phase I. Project is a
federal cost-share with INDOT – requesting new PO. See attached memo
with explanation.
For Change Orders Only
Reflecting *Total* Project Cost (Federal and Local Funds)
Amount of Increase
Decrease
$68,665.95
($ )
Previous Amount $ 1,802,596.85
Current Percent of Change:
Increase
Decrease
4.2%
( %)
New Amount $ 1,871,262.80
Total Percent of Change:
Increase
Decrease
15.2%
( %)
Time Extension Amount: None
New Completion Date: