HomeMy WebLinkAboutChange Order No 2 & PCA - Northwest Elevated Tank Improvements Proj No. 122-018 - Viking Ind. Painting, LLC1316 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 25, 2023
Mr. Luan Ha
Viking Industrial Painting, LLC
10905 Harrison St.
La Vista, NE 68128
lhakviptanks.com
RE: Change Order No. 2 (Final)/Project Completion Affidavit
Northwest Elevated Tank Improvements - Project No. 122-018
Dear Mr. Ha:
At its July 25, 2023 meeting, the Board of Public Works approved the Final Change
Order for this project, be decreased by $35,500. The final contract amount is $1,185,155.
In addition, the Project Completion Affidavit for this project was approved in the amount
of $1,185,155. Copies of the Change Order and Project Completion Affidavit are enclosed 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
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER
INTER -OFFICE MEMORANDUM
DEPARTMENT OF PUBLIC WORKS
DIVISION OF ENGINEERING
TO: Theresa Heffner, Clerk
Board of Public Works
FROM: Rebecca Plantz, Project Engineer
SUBJECT: Change Order 2, Project No. 122-018
Northwest Elevated Tank Rehabilitation Project
DATE: July 14, 2023
Change Order 2 to the Northwest Elevated Tank is to decrease the contract amount by
$35,500.00. This deduct is to cover estimates for the City to complete remaining punch list items
and close out the contract with Viking Industrial Painting. Two options were proposed to the
contractor; extend the contract time to complete punch list items to an acceptable, standard
quality, or decrease the contract in the amount of remaining work for the City to complete the
tasks. Punch list items include site restoration, valve vault hatch repair, valve vault insulative
pipe coating failure repairs, and replacing the damaged FAA light. All parties agreed to proceed
with the deductive change order and closing the contract out with Viking Painting.
Please call with your questions (5998).
CITY OF SOUTH BEND
DEPARTMENT OF PUBLIC WORKS
PROJECT CHANGE ORDER
DATE:
PROJECT NO:
PROJECT NAME:
CONTRACT DATE:
CHANGE ORDER NO.
SUBJECT OF CHANGE ORDER:
July 14, 2023
122-018
Northwest Elevated Tank Rehabilitation Project
August 9, 2022
2
Deduct for the amount to close out the project and complete
punch list items.
The original contract sum
Net change by previously authorized change orders
The contract sum prior to this change order
By this Change Order, the project amount is
The new contract sum including this change order
This Change Order represents a total change of
Total change for entire project
Original contracted completion date/time
Extension of date/time by previous change orders
Date/time extension by this change order
New completion date/time
CONTRACTOR
Contractor Signature
Luan Ha, Project Manager
Printed Name and Title
Viking Industrial Painting
Company name
10905 Harrison Street
Address
La Vista, NE 68128
City, State, Zip
❑ Increased
® Decreased
$ 1,228,400.00
$ 7,745.00
$ 1,220,655.00
$ 35,500.00
$ 1,185,155.00
2.89 %
3.52 %
December 24, 2022
97 days
March 31, 2023
RECOMMENDED FOR APPROVAL
t j"- ' ff- V
PROJECT MANAG R
CITY OF SOUTH BEND
BOARD OF PUBLIC WORKS
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Murray L. Miller, Member
Joseph R. Molnar, Vice President
Jordan V. Gathers, Member
4
Attest: Theresa M. Heffner, Clerk
Date: July 25, 2023
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME
PROJECT NO.
Northwest Elevated Tank Rehabilitation Project
122-018 FINAL COST $1, l 85,155.00
CONTRACT SIGNED August 9.2022 MAINTENANCE AGREEMENT ENDS
PROJECT Install new coatings for the Northwest Elevated Storage Tank as well. as
DESCRIPTION several minor site and structure improvements.
WITNESSETH:
The work under the above contract between the City of South Bend and the undersigned contractor having been
completed, the City of South Bend, its officials and agents are hereby released from all claims and dernands
Nvhatsoever arising under or by such contract, and that the contractor performed the work within the scope of the
Specifications and Standards of the City of South Bend which were a part of the above Contract.
Executed this 20th day of Ju1Y , 20 23
Sigrr ,
Serena Ee6 Stach
Printed Frame
VikinE Painting LLC
Company Name
PO Box 24162
Company Address
Omaha, NE 68128
City/State/7ip
WITNESS
Before me, the undersigned Notary Public in and for said country and state, personally appeared
and acknowledged his/her signature to the above Project Corn letion AF, (_1avit
-)n the day o , 20�3 DOMINIC PEDERSEN
General Notary - State of Nebraska
-- My Commission Expires Se 11 2026
96 ary Signatu My Commission __ ires
h4c�i._i- It xtt:SI L
rintedName Countyof'Residence
If the Contrac corporation, the following certificate will be executed. �l
I _ certify that I am Secretary of the Corporation executing this release. that
who this release on behalf of the contractor waS ,hen
of said Corporation, aid release was duly signed for and on behalf of
said Corporation by Authority of its governing body, and is wr e scope of corporate powers:
Secretary's Signature
Corporate Seal
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable for final approval and we recommend to the Board of Public Works that it be
ordained so.
Date:
Construction Manager
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
taLtk
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Murray L. Miller, Member
Joseph
✓R. Molnar, Vice President
JordanV. Gathers, Member
Attest: Theresa M. Heffner, Clerk
Date: July 25, 2023
AFFIDAVIT AND WAIVER OF LIEN
State of ^,iAraska, County Of Douglas SS:
Rory Sudbeck being duly sworn that he/she is the President
(Name of Officer) (Title)
of Viking Painting I.L.C_ _ having contracted with City of South Bend, IN
(Subcontractor/Supplier) (Owner____
to furnish certain materials and/or labor as follows: Rehab Water Tank
for a project lalown as Northwest. Elevated Tank Rehablitation Project
(Name of Project) — - --- --
located at City of South Bend, IN
and owned by City of South Bend, IN
(owner)
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL 'WAIVER) that there is due from the (Owner) the sum of
Dollars
❑ receipt of which is hereby acknowledged; or
❑ the payment ofwhich has been promised as the sole considerations for this Affidavit and Final Waiver of Lien which is given
solely with respect to said amount, and which waiver shall be effective only upon receipt of payment there:af by the
undersigned;
(FINAL WAIVER) that the final balance due from the contractor is the sum of
Twenty Nine Thousand Five Hundred Fifty -Six Dollars and 00/100 0 9 556.Ot) )
❑ receipt of which is hereby acknowledged; or
th- payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien WEcw shall
become effective only upon receipt of such payment.
T{iF'REFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever
on the above-des;uibed property and improvements thereon an account of labor or material or both, furnished b the undersigned
thereto, sul jest to limfMiuns or conditions expressed herein, if airy; and further certified that no other party has any claim or right to a
Hen on account of any work performed; or material fumished to the undersigned for said project, and within the scope of this Affidavit
and Waive~.- ofiLiwo.
By
(Fir (Authorized Representative) 1",P-1-
STATE OF Nebraska ) SERENA L. STACH
SS: General Notary - State of Nebraska
g COUNTY . ) My Commission Expires Dec 20, 2023
Douglas
#etcereme, the undersigned, allotan, Public, in a . forsaid Col:. it:, s ej State, personally appeared 5W(6cL
and aclmow lodged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS WfEREOF, I have hereunto subscribed my name and affixed my official seal on the � day of
20915
My Commmir -,'on Expires:
Residing in _ a�rl2'��l �� County, „�� Notary Public Name
227 W.JEFFERSON BOULEVARD
SUITE 1316
SOUTH BEND, IN 46601-1830
PHONE: 574/235-9251
FAx: 574/235-9171
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
July 14, 2023
Mr. Luan Ha
Viking Industrial Painting
10905 Harrison Street
La Vista, NE 68128
Re: Northwest Elevated Tank Rehabilitation Project
Project No. 122-018
Dear Mr. Ha:
Attached please find Change Order 2 & Final and the Project Completion
Affidavit for the above referenced project. Please return one executed copy of each
along with the Final Waiver of Lien. Please submit all the necessary paperwork at the
same time. A Final Pay Application with a release of the remaining dollars after Change
Order 2 results in a total payment of $29,556.00. Please submit Pay Application 5 with
the representation of Change Order 1 and Change Order 2 in the Change Order
Summary, along with an `Amount Due This Application" of $29,556.00. This payment
will release for processing after the Board of Public Works signs off on Change Order 2
and the Project Completion Affidavit on July 25, 2023.
Thank You for your cooperation in this matter. Please contact me at 574-235-
5998 if you have any questions.
Sincerely,
Rebecca Plantz
Project Manager
City of South Bend
Department of Administration & Finance
Change Order Request Form
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.
Multiple PO lines:
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.
Project POs:
For change orders on project -related POs, this form must be approved by the Project Accounting Team as described in
Supplement 508.
PO Number
PO-0018335
Line Number
2
Original Dollar Amount
$65,056.00
New Dollar Amount
For liquidation request, enter $0
$29,556.00
Reason Code if changed)
Financial Dimensions (fund-dept-
division -subdivision -main account
622-06-604-620-442010
Project Code if applicable)
PROJ-319
Description of change (include
budget impact)
Change Order 2: Deduct contract by $35,500 for Owner to cover punch list items and
close the project out with Viking Painting.
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)
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)
PO Number
Line Number
Original Dollar Amount
Change Order Request Form P018335 - CO2 1 of 3
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 07/14/2023
Name Becca Plantz Department Public Works
BPW Date 07/25/2023 Phone Extension 5998
Review and Approval Required Prior to Submittal to Board
Diversity Compliance
and Inclusion Officer ❑ Officer Name Cynthia Simmons
BPW Attorney
❑ Attorney Name
Dept. Attorney ❑ Attorney Name
Purchasing ❑
Michael Scmidt
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. 2 ❑ PCA
❑ Chg. Order, No. 2 ❑ Traffic Control ❑ Resolution
n Other: n Ease./Encroach
Information
Company or Vendor Name Viking Painting, LLC
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of ❑
Previous Amount
U YesU If Yes, Approved by Purchasing
❑ No
❑❑ WBE Completed E-Verify Form Attached ❑ Nos
Northwest Elevated Tank Improvements
122-018
Water Works Capital — Distribution /Reservoirs
PROJ 319
$1,228,400.00
Lump Sum
Change order 2 to deduct the contract in the amount of remaining punch list
items and project closeout.
For Change Orders Only —
Increase $
Decrease
$1
($ 35,500.00)
055.00
Increase %
Current Percent of Change: Decrease (2.89%)
New Amount $ 1,185,155.00
Increase %
Total Percent of Change: Decrease (3.52%)
Time Extension Amount:
New Completion Date: