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Home My WebLink AboutChange Order No 1 & PCA - Multi-Component Striping Proj No. 122-065 - Traffic Control Specialists1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS March 12 2024 Mr. Brian Triska Traffic Control Specialists, LLC 1810 W. Pacific Ave. Knox, IN 46534 estimatingktcspecialists.net; rikktcspecialists.net RE: Change Order No. 1 (Final)/Project Completion Affidavit Multi -Component Striping - Project No. 122-065 Dear Mr. Triska: At its March 12, 2024 meeting, the Board of Public Works approved the Final Change Order for this project, be decreased by $1,258.17. The final contract amount is $16,580.77. In addition, the Project Completion Affidavit for this project was approved in the amount of $16,580.77. 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, Is/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/lh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BRIANA N. MIcou CITY OF SOUTH BEND, INDIANA DEPARTMENT OF PUBLIC WORKS - k PROJECT CHANGE ORDER DATE: 7/1 /2023 PROJECT NO: 122-065 PROJECT NAME: Multi -Component Striping CONTRACT DATE: 12/20/2022 CHANGE ORDER NO: 1 (Final) SUBJECT OF CHANGE ORDER: PCR #1-Underrun quantity adjustment All items completed substantially as planned. See attached Comparison of Estimate for overruns and underruns. 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 Fear Tk�k BrianTni ka(Jan 18, 202411:34 CST) Contractor Signature Brian Triska, President Printed Name and Title Traffic Control Specialists, LLC DBA High Star Traffic Company Name 1810 W. Pacific Ave. Address Knox, IN 46534 City, State, Zip $ 17,838.94 $ 0.00 $ 17,838.94 ❑ Increased X❑ Decreased $ 1,258.17 $ 16,580.77 -7.05 % -7.05 % 5/17/2023 0 days 0 days 5/17/2023 RECOMMENDED FOR APPROVAL X ,L-1�Gv- CO TRUCTION MANAGER CITY OF SOUTH BEND CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS 4� Elizabeth A. Maradik, President a0,A.A Gary A. Gilot, Member 4 XA Murray L. Miller, Member Joseph R. Molnar, Vice President t�G— Briana Micou, Member (4 Attest: Theresa M. Heffner, Clerk Date: March 12, 2024 222457 PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Multi -Component Striping 122-065 FINAL COST $16,580.77 12/20/2022 MAINTENANCE AGREEMENT ENDS City of South Bend MC Striping Chippewa & Michigan Intxn 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 demands whatsoever 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 28th day February 2024 Signature Brian Triska, President Printed Name Traffic Control Specialists, LLC Company Name 1810 W. Pacific Ave. Company Address Knox, IN 46534 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Brian Triska , and acknowledged his/her signature to the above Project Completion Affidavit on the 28th day of February 12024 Notary Signature My Commission Expires Dawn L. Bennett Printed Name County of Residence \AY ' , DAWN L. BENNETT o•••••�s'c Notary Public, State of Indiana 10/2 12U�AL• - Starke County i ' nN u mb-rNP0723106 i' •'Np,; My Commission Expires October 20, 2027 Stark If the Contractor is a corporation, the following certificate will be executed. I, certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name Corporate Seal 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. Ala& .L. 4al. eLtt- Date: 2/29/2024 Co&fstruction Manager President Member BOARD OF PUBLIC WORKS APPROVAL Date: Member Member Member Member 222457 Final Waiver of Lien State of Indiana, County of Starke SS: Brian Triska being duly sworn that he/she is the President (Name of Officer) (Title) of Traffic Control Specialists, LLC having contracted with City of Southbend (Contractor) (Owner) to furnish certain materials and/or labor as follows: (Description) for a project known as City of South Bend MC Striping (Name of Project) located at Chippewa & Michigan Intxn and owned by City of South Bend (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Eight Hundred Twenty -Nine an Dollars ($_ 829.04 ) ❑ receipt of which is hereby acluiowledged; or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lion -which is given solely with respect to said amount, and which waiver shall be, effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever on the above -described property and improvements thereon as account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lieu \ 0k _ Traffic Control Specialists LLC By (Firm) (Autho 'zed Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Brian Triska and aelaiowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WBEREOF, I have hereunto subscribed my name and affixed my official seal on the 26th day of February 20a 24 ` Notary Public Signature My Commission Expires: 10/20/2027 j Residing in Starke County, _In DAWN L. BENNETT �P.••••.4�'c Notary Public, State of 1115 n= r,.,.,Starke County—�.--U SEAL' =, rr,rr ion Number NP0�2�9t M Com,misslon [x >ires v NP P� y October 20, 2027 L. Bennett Name BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 02/29/2024 Name Kvle Ludlow Department Public Works BPW Date 03/12/2024 Phone Extension 9157 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Re uired or 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. 1 ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution n Other: n Ease. /Encroach Information Company or Vendor Name Traffic Control Specialists, LLC New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract U Yes U If Yes, Approved by Purchasing ® No MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos Multi -Component Striping 122-065 PR-00021150 PR-00000402 PO-0020953 $16,580.77 Purpose/Description _Project Closeout and Final Change Order For Change Orders Only Amount of ❑ Increase $ ® Decrease ($ 1,258.17) Previous Amount Current Percent of Change New Amount Total Percent of Change: Time Extension Amount: New Completion Date: $ 17,838.94 Increase % Decrease $ 16,580.77 Increase Decrease 0 days 5/ 17/2023 -7.05% -7.05%