HomeMy Public PortalAboutChange Order No. 12 to Contract No. 148...82810 - Bike Pedestrian facilitiesContract No: R -37453
INDIANA Department of Transportation
Construction Change order and Time Extension Summary
Change Order No.: 012
Page: 1
Contract Information
Contract No.: R -37463
Letting Date:1011212017
District:GREENFIELD DISTRICT
AE:Prather, Michael
PE1S:Stanley, William Status:Draft
Change order Information
Change Order No.: 012
EWA: Y or Force Acct: N
Date Generated: 04/29/2019
Date Approved: 00/0010000
Reason Code: CHANGED COND, Constructability Related
Description: 2nd Street Storm Water Inlets and MOT
Original Contract Amount
$ 5,883,000.00
Current Change Order Amount
$ 4,3'13.87
Percent: 0.073 %
Total Previous Approved Changes
$-30,119.55
Percent: -0.512 %
Total Change To -Date
$-25,805.88
Percent: -0.439 %
Modified Contract Amount
$ 5,857,194.12
_
Time Extension Information
Date Initiated 00/0010000 Date Completed 00100/0000
Original Contract Time SS Completion Date 11 /3012018 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP = Special Provision)
Time Element Description: One addtional Day calendar day has been requested by the contractor to complete this
work
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 CalendarMork Days 1
SS Date 00/0010000or SP Da s 0
Revised SS Date per this C will be 7/1119
Contract No: R -37453
INDIANA Department of Transportation
Construction Change order and Time Extension Summary
Review and Approval Information
Required Approval Authority
($ per Change order)
(Days per Contract)
Verbal Approval Required?
Total Change To-Date>5%?
Scope/Design Recommendation
Required?
Change order No.: 012
Page: 2
AE: M.PrathetCE: SCE: * DDCM:
-LE$250K-} LE$750K-}{_-LE$2MGT$2M--}
50 SS days } 100 SS days } 200 SS Days } GT 200 SS days}
Y 1 N If Y, b G. Steins Gate Issued 10/25/18
Y
Y if Y , Copy to Program Budget Manager
Y 1 N If Y, Referred to Project Manager(PM)
Date to PM Date Returned
Approval Authority Concurs with PM? Y 1 N If Y, Concurrence by
If N,Resolution: Approved
Resolved by
LPA Signatures Required? Y 1 N 1f Y, Date to LPA 4/29119
FHWA Signatures Required? Y 1 N If Y, Date to FHWA
* Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer Date
Comments:
Date
Disapproved
Date
Date Returned
Date Returned
Contract No:R--37463
Change Order No:9 1 2
INDIANA
Department of Transportation
Date: D413D120 1 9
Page: 3
Contract: R -37463
Project: 1382814 - Stater 38281 OOOLC3
Change Order Nbr: 012
Change Order Description: 2nd Street Storm Water inlets and MOT
Reason Code: CHANGED COND, Constructability Related
CZwN. PCN PLZV. .. Item fCode .. _ [3n•it ._..• :_..: _ _ .. _r_ .�-.�,..... _ ._.. � _ _ ..._ _ ....... _ _ ......,_ ..,__..:,:-._ ,._ _ . , _: .. , -A..,.._ ......._._ . _ _._ ._ .
Unit Price Co Qty Comment Amount Chan.__ge
0179 1382810 0179 720-09079 EACH 1,437.890 3.000 C Amount:$ 4,313.67
Item Description: INLET HA5 MODIFIED
Supplemental ❑escriptionl: Includes No 53 stone for MOT
Supplemental Description2: 2nd and Main Street
Total Value for Change order 012 = $ 4,313.67
Contract Completion Date Time Adjustment
Original Completion dt: 11130120188130119Adj compi dt 711119 Adj No. of Days 1
Explanation: one addtional Day calendar day has been requested by the contractor to complete this work
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
This Change order was submitted January 28, 2019 for Milestones work to digout and install 3 inlets with No 53 Stone placed for MOT to open
2nd street back up to traffic. A Lump Sum amount was submitted for consideration but is being processed by the closest item type of an HA5
Inlet, Modified to include the cost of the stone and additional excavation. Milestone submitted the request for change document along with labor
and material summary which has been attached to this CO as supporting documentation. Milestone performed the work on October 25, 2018.
Foreman dailies are also attached as supporting record of work performed. The material quantiles and support information submitted by the
contractor appears to sufficiently justify the claim. Additional Work also included in the unit price are MOTdevices, saw cut and coring of inlet, and
placement of inlet protection. The work was performed near station 39+53.41 RT One addtional work was requested as part of this Change
Order bringing the revised calendar comlpeticn date to July 1, 2019
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.
Mnestofie Contractors, Lop,
Contractor: Signed
Date: a q-
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Contract No: R -37463 I NDIANA Date:0413012019
Change Order No•:012 Department of Transportation Page: 4
APPROVED FOR LOCAL PUBLIC AGENCY
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TURE) (TITLE) (DATE)
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i Ott* tt R#y!###itititf#*!#i###t�k#rkiii#i# * i # #}I*fitlf!#tftft*ti###itltY�M#####
SUBMITTED FOR CONSIDERATION
PEIS ..�..
S
APPROVED FOR iNDIANA DEPARTMENT OF TRANSPORTATION
Approval Level Name of Approver Date Status
dfla
P.
N.N06RDERREQUEST FORM
` January 28,
CONTRACT NO. R-37463-B DATE OF SUBMISSION 2019 '
PROJECT DESCRIPTION ENHANCEMENT, BIKE AND PEDESTRIAN FACILITIES. WAYNE
COUNTY, ON E MAIN ST, 7TH ST AND 10TH ST IN THE CITY OF
[rDute � intersection f bridge RO{s�. j RICHMOND, IN
CHANGE ORDER REQUEST SUMMARY 3 2'"111 STREET MOT PER THE CITY
DESCRIPTION
PROPOSED SOLUTION SUMMARY Milestone performed digout, installed 53 stone, and installed 3 inlets.
NOTE: Upon request from Engineer, enter detailed description on poge 2.
ONSET DATE OF CHANGE 1Sett Do&a CHANGE ORDER TYPE 104.03 Extra Work
PROPOSED COST AND TIME ADJUSTMENT
COST COST INCREASE / (DECREASE €
}: $ 4,313.67
The cost adjustment shall include lump sum and estimated totaled unit -priced item costs. Attach a separate sheet of unit price items
including item description, unit of measurement, estimated quantity and unit price.
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF COST CHANGE:
❑ 109.03 Altered Quantities ❑ 109.05(a) Agreed Price ❑ 109.05(b) Force Account ❑ 109.05.02 Delay Costs
PROPOSED COST CHANGE INCLUDES: 9 Labor 0 Material 'Z Equipment ❑ Lease Agreement C°
Subcontractor
TIME ADJUSTMENT INCREASE / (DECREASE): (work days) 1
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
❑ 108.08(a) Excusable, Non-Compensable Z 108.08(b) Excusable, Compensable
NOTE: if Compensable, attach details based on 109.05.2(a) Allowable Delay Costs.
SUPPLEMENTAL INFORMATION
Additional information may be entered by the contractor.
CHANGE ORDER ORIGINATION: iNDOT 1 LPA Cx] Contractor
DOCUMENTS AFFECTED:
❑ Contract Specifications (ref. doc name/no.) NIA
❑ Contract Plans (ref. doc name/no.) N/A
CHANGE ORDER AFFECTS DBE PARTICIPATION: ❑ yes 9 no (if yes, attach details)
I r IQf;3 1_'
V
CHANGE QRUER REQUEST FORM !
{
k i i
CONTRACT NO. R-37463-B
I
i
UPON WRrrTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL
DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF
1 ADDITIONAL DETAIL [select Date] ADDITIONAL DETAIL [Select Date]
DETAILED DESCRIPTION f JUSTIFICATION:
(include loco tion(s), actions of con tractor, owner, and other stakeholders, key events and related cause(s), discoveries,
discussions, meetings, and effect on the contract if no action is token. Also include references to key documents attached
I
or available to support this change order request.)
t
Milestone performed digout work at 2nd Street, installed #53s stone, and installed 3 Inlets at the location
per City's request. f
1
i
s
PROPOSED SOLUTION -- ADDITIONAL DETAILS:
(include proposed scope of work, means & methods, materials, equipment, utility relocotion required, subcontracted
scope and the effect on the contract schedule. Also include references to attached documents including, but not limited
to, sketches, calculations, photos, material information, and submittals and meeting minutes.)
Milestone performed digout work at"d Street, installed #53s stone, and Installed 3 inlets at the
{ location.
{
_
i
i
SIGNATURES
4 Contractor: '
*,M
Name: (print) r t r
(signature) •r - Date: 01/28/19
Project Engineer/Supervisor: (signature is to ocknov-ledge receipt of the document and does not signify agreement of the chong,e order)
Name: (print) 0hristopher J Miller
Digitally signed byChrts Miller
(sionatu rej _• _ _ %
' o _ � ON: to=Chris Mille:, o� o�, Date: to : 4 2 9
ris m� er�uC=n .tam, c-
D [e: Z�19. �.i 1: 8:48.04'Od' '
NOTE. The Controctor and PE/S should retain o sfgne�cnP� e?6rrs os" urnent�vr record.
CHANGE ORDER REQUEST FORA
CONTRACT NO, R-37463-B
ATTACHMENT: UNIT PRIDE ITEMS DETAIL
Attach or paste a unit price item detail.
tit ur ? N D SI~ R E Err & NIA I N
I LUMP SUM C S4,313.67/LU?v1P SUM = $4,313.67
Milestone Contractors, L.P.
Extra Work Pricing.
Summary
Project No:
99950-813
Date Requested:
TO
Date Submitted:
1 /25/2019
INDQT R-37463-B
Description of Work:
MOT 2ND STREET & MAIN
Reason for Extra Work:
INDOT REQUESTED
Has Mork Already Been Completed? YES
When: 25-Oct "18
THROUGH
25-Oct-18
MCLP Project No.
184003 Cost Activity Code:
99950-813
Item:
Quantity: 1
Units
LS
Labor:
Cost = $2,475.01 Markup %
20% S 495.00
Total
$ 29970.01
Equipment:
Cost = $579.52 Markup f
12% S 69.54
Total
$ 649.06
Materials:
Cost = $609.42 Markup %
12% S 73.13
Total
S 682.55
Subcontract:
Cost = $ - Markup °f
10% S -
Markup %
7% S -
Total
$ _
Trucking;
Cost = $ - Markup %
12% 5
$ 3,663.95
S 637.67
S 4.301.62
Insurance & Bond
Cost = $ 10.75 Markup 1
12% S 1.29
Total
$ 12.04
Total
S 4,313.67
Unit Price
$ 4131 .67
Extra Days Requested 1
•18,1003-99950-813-NIOT 2nd S.t & tvaain Page 1
MILESTONE CONTRACTORS, L.P. IMCLP 9. 99950-813
FORCE ACCOUNT WORK
CUSTOMER NO.
Markup 'Trill be added per 1NDOT or CONTRACT speCdcalrans for Fare Arccunt Work DATE 10125118 TO 10125/18
DESCRIPTIOMISCOPE OF WORK: 1NDOT R-37463.8
1410T 2ND STREET & MAIN
ADDRESSILOCATION
JOB NO: 184003 DATE EFFECTIVE:
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