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Home My Public Portal AboutChange Order No. 18 to Contract No. 148...82810 - Bike Pedestrian facilitiesContract No:R -37463 Change Order No.: 018 INDIANA Department of Transportation Page: I Construction Change order and Time Extension Summary Contract Information Contract No.: R -37463 Letting Date:10/12/2017 District: GREEN FIELD DISTRICT AE:Prather, Michael PEIS:Stanley, William Status:Draft Change order Information Change Order No.: 018 EWA: Y or Force Acct: N Date Generated: 04/30/2019 Date Approved: 00/00/0000 Reason Code: CHANGED COND, Constructability Related Description: Replace Power Feed to Existing Signal Controller Original Contract Amount $ 5,883,000.00 Current Change Order Amount $ 1,95'1.77 Percent: 0.033 % Total Previous Approved Changes $-301119.55 Percent:--0.512 % Total Change To -Date $-28,167.78 Percent: -0.479 % Modified Contract Amount - $ 5,854,832.22 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 -37463 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.: 018 Page: 2 AE: M.Prather DCE: SCE: * DDCM: (-LE$250K-)(-LE$750K-)(--LE$2M--)(--GT$2M--) ( 50 SS days) (100 SS days) (200 SS Days) (GT 200 SS days) Y / N If Y, by G. Steins Date Issued 10/29/18 Y / N If Y ;Copy to Program Budget Manager Y / N If Y, Referred to Project Manager(PM) Date to PM Date Returned Approval Authority Concurs with PM? Y 1 N If Y, Concurrence by If N,Resolution: Approved Resolved by LPA Signatures Required? Y1 N If Y, Date to LPA 4/30/19 FHWA Signatures Required? Y 1 N If Y, Date to FHWA * Field Engineer Recommendation (Required for SCE or DDCM Approval) Field Engineer Date Comments: Date Disapproved Date Date Returned Date Returned Contract NoKR -7463 INDIANA Date:04/3012019 Change. -Order No:016 Department o Transportation Page-: 3 moist'"x9�.»"'e"+QY!°y�r*`,�`X'�p°F'sx-.�'°.j;�C •.e".:°;at:r;am ar'uSf�w,.ssyg<w.:s^�v?.+;Y.Y.t>c7�:?nesixa+:?N.oam.:+:"'¢�'a�-'w:'�iW!t-^. +st^v�;na�+sc�r .�"y"'. ==g.�,.,h.;.....-.,.W2csc�..a.. ..aa ax:xeaevxwrw+�vca:-wawrsssx�sw„..,"a,..nHm* Contract: R '37463 i t'o 6t. 138210 w State.Y1 38281 0\./1��r C Change :Order N�br: .018 Change O rd6e De'scrip#ion: Repiade' Power Peed to E.�istind Signl Controller reason Code: CHANGED' oND', Owstructabiiity.Related �CLN PG�I PLN item fade �lnit Unit la�riceDt� Q#�. C�mr�ent Amvun� �Gf�ange .0185 1882810 0185 .80MZ9 60 LS- 1195.1.770 1.000 :C Amounf,$= i,951.77 .tteM -Descripftion: ELECTRICAL WOkK Supplementaf Des!:00onI: Remove and. Replace. Supplemental Ddscr1'pt11dn2:- EX' Ii ing-Sig6al- Pow6r- Feed Total Value -for.-Change Order 018 = - " whereas, the Standard SpecificMiQns for this Gd-Oftaci provides four. such work%to be.peffvrined, the-folloWtng change is recomimended, 'General. or Standard 0hange Drder.Explanation `["hit change-oMer c'M bbnsates MiiWnne and-James.H Qrew for Work:bompleted -to-install •a riew- power feed to. the existing signal-(oc;ated -at 3rad- and lain. There- was. -an,existing handhole that will now baWthin the Maih Street and 3rd Street intersectlan which contained the.power-feed frorn RPL which powers the.existing trafFic signal at the intersection.. RPL.does pot Want to work-iri the existing tnanhate W ause.their.did not install it4nd the existing c€7ndition is a patchwork syrsten that.has -been cobbled'tagether-over the_ybars. The-aervice has been hitseveral times .and spliced together Gills NWth-INE)OT reviewed thiswith Milestone'and.with Mike Prather- afteir a-proores!§ nisieting-,on. 'October-17, 2018; The CIty. requested RPL.ta proviide�.:at prlco-.for-setting-'a� new ha�ndhole'and'running oeav po%ver,:t6 tie sigri�l cabinet; This' vv rk would eliminate the exlsiing servlde .and provide,a new power feed to the -existing controller cabinet -,Greg Steins requested thts work be performed -as part'.of the -project sine the area is already under construction. A -breakdown of.costsassociated with this work has been'included with this -change order �s:.supporting'd4�r�rnentation.. The. �rork was completed do Qctober '2J, -201-8. Dhange.Order Explanaiton. 'for Spa ciftc Line Item *yk�f,Tr�k�r!#�1r,Y,��k+k****�*#*arfer!**it�ir�rf��t+t�#'�**+�'�' k*iri#t#�t�*frl�.t�*k�#fts:�k��k �rieacit it,►yY� *{��?�#,k�*atit+t*1�1�► �k#itdr�4-+�r�4yRki��k��#it-A,t�t+�*�k# �k#� Ifis theintent ofthe parties thakhis change -order is full and complete compensatfon_for the work desc i -above. Notifica.tiorvand cohsent.toAhis change order is hereby acknoWlddged: e we -Contractors;. LwPm - . Ontradtar'.. Signed -By: 'NOTE:'Other'required :State acld FHWA: sigriatUr" s `,wilt 'b'e dbt�ined electronicatly through t4d S1tWa`nager`sgUe' M. Contract No:R -37463 INDIANA Date:04/30/2019 Change Order No:018 Department of Transportation Page: 4 APPROVED FOR LOCAL PUBLIC AGENCY C L'OOF URE) (TITLE) (DATE) (SIG URE) (TITLE) (DATE) -fF ,on SUBMITTED FOR CONSIDERATION Ae .0001�� APPROVED FOR INDIANA DEPARTMENT OF TRANSPORTATION Approval Level Name of Approver Date Status CHANGE ORDER REQUEST FORM CONTRACT NO. R-37463-B " DATE OF SUBMISSION April 15, 2019 ' PROJECT DESCRIPTION ENHANCEMENT, BIDE AND PEDESTRIAN FACILITIES, WAYNE COUNTY, ON E MAIN ST, 7TH ST AND 1OTH-ST IN THE CITY OF (route / intersection % bridge no(s).) R10 HMON D, IN CHANGE ORDER REQUEST SUMMARY INSTALL NEW POWER FEED TO THE CONTROLLER CABINET AT 3Ro{ DESCRIPTION AND MAIN PROPOSED SOLUTION SUMMARY JAMES H DREW, SUBCONTRACTOR TO INSTALL POWER FEED TO CONTROLLER CABINET NOTE: Upon request from Engineer, enter detailed description on page 2. ONSET DATE OF CHANGE [Select Date] CHANGE ORDER TYPE 104.03 Extra Work PROPOSED COST AND TIME ADJUSTMENT : COST INCREASE DECREASE COST j (DECREASE): $ 1,951.77 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: ❑ Labor ❑ Material ❑ Equipment ❑ Lease Agreement 0 Subcontractor TIME ADJUSTMENT INCREASE j DECREASE): (workdays) 0 CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: ❑ 108.08(a) Excusable, I4on-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 ma-y be entered by the contractor. CHANGE ORDER ORIGINATION: ❑ INDOT / LPA N Contractor DOCUMENTS AFFECTED: ❑ Contract Specifications (ref. doc name/no.) N/A ❑ Contract Plans (ref. doc name/no.) N/A CHANGE ORDER AFFECTS DBE PARTICIPATION: ❑yes l no cif yes, attach details) i i E Ver. 10.23.17 CHANGE ORDER REQUEST FORM CONTRACT NO, R-37463-B UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF E ADDITIONAL DETAIL. 5elect Dated ADDITIONAL DETAIL [select Date] DETAILED DESCRIPTION / JUSTIFICATION: (Include loCQtion(s), actions of contractor, owner, and other stakeholders, key events and related cause(s), discoveries, discussions, meetings, and effect on the contract if no action is taken. Also Include references to key documents attached or available to support this change order request.) s OWNER REQUESTED INSTALLATION OF ANEW POWER FEED TO THE CONTROLLER CABINET AT 3R° AND MAIN — JAMES H DREW CORPORATION, SUBCONTRACTOR, PERFORMED THE WORK. PROPOSED SOLUTION -- ADDITIONAL DETAILS: - (include proposed scope of work, means & methods, materials, equipment, utility relocation 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 HAD SUBCONTRACTOR, JAMES H DREW CORPORATION, PERFORM THE INSTALLATION OF A NEW PONDER FEED TO THE CONTROLLER CABINET. SIGNATURES Contractor: Name: (print) OTT T R It/ I (signature) � Date: 04/151/9 Project Engineer/Supervisor: (signature is to acknowledge receipt of the document and does not signify agreement of the change order) Name: (print) Christopher J Miller Digitally signed by Chris Miller (signature) DN: cn--Chris Miller, o, ou, Date: %..6 hi I I a 1 V41 11 %. I emai x ns.mi er@uc n y.com, Fas Date: 201 Q 01 :Q1:06-04'00, NOTE. The Contractor and PE/5 should retain a signed copy a t�rs Xacument for record. 4/3 D/l9 2 CHANCE ORDER REQUEST FORM CONTRACT NO. R-37463-B ATTACHMENT: UNIT PRIDE ITEMS DETAIL Attach or paste a unit price item detail. .DAMES H DREW PERFORMED THE WORK THAT WAS COMPLETED 04/08/19 WE REQUEST CHANGE ORDER FOR THE WORK: INSTALL POWER TO CONTROLLER CABINET 3RD & MAIN I LUMP SUM @ $11981.77 = $71951 w77 pi). 3 Ivi ikq Milestone Contractors, L.P. = Extra Work Pricina Summa Project No: 184003 Date Requested: TO Date Submitted: 4/12/2019 1NDOT R-37463-B BIKElPED ENHANCE Description of Work: JAMES H DREW - INSTALL. A NEW POWER FEED TO THE CONTROLLER CABINET AT 3RD & MAIN Reason for Extra Work: 1NDOT REQUESTED Has Work Already Been Completed? YES When: 29-Oct-18 THROUGH 8-Apr-19 MCLP Project No. 184003 Cost Activity Code: 184003 item: Quantity. 1 Chits LS Labor: Cost = $0.00 Markup X 20% S - Total $ - Equipment: Cost = $0.00 Markup % 12% S - Total $ - Materials: Cost = $0.00 Markup % 12% 5 - Total $ - SubcoRtract. Cost = $ 1,769.38 Markup % 10% S 176.94 Markup % 7% S - Total $ 1,946.32 Trucking: Cost = $ - Markup / _ 12% S - $ - $ 1,769.38 S 176.94 5 1.946.32 Insurance & Bond Cost = $ 4.87 Markup,% 12% S 0.58 Total 5 5.45 Total 5 1,951.77 Unit Price 1 LS $ 1,951.77 Extra Days Requested 0.0 184003 R-37463-B inst Power to Cont Cabinet Page 1 ICI FORCE ACCOUNT/EXTRA WORK JAMES H. DREW CORPORATION Submitted By DREW JOB NO. 518569 PROJECT NO. DATE October- 29, 2018 CONTRACT R-37463 Description Change Order Cost Install 2 fiberglass handholes. Not responsible for pulling wire. Conduit to be installed per Each contract. Quantity (2) $ 884.89 LARaR 10CP_04 (a.) WP:F= { FNnimr..- �ELECTRICIAN- �0�0�000�� !COMBINATION LABORER FICA 7.65% X LINE (1) FRINGES ELECTRICIANS 0. HRS X 22.49 = LABORERS 0 HRS X 15.16 = OPERATORS 8 HRS X 18.41 = TEAMSTERS a HRS X 15.74 0 HRS X - _ WORKMEN'S COMPENSATION BODILY INJURY INSURANCE PROPERTY DAMAGE INSURANCE STATE UNEMPLOYMENT FEDERAL UMPLOYMENT TRAVEL ALLOWANCE OR SUBSISTENCE (NOTE #3) TOTAL LINES 1, 2,314,5,617,8,&9 20% X LINE (10) GRAND TOTAL LABOR LINES (10) + (11) I U I AL LAbUK TOTAL FRINGES 2.84% X LINE (1) 4.50% X LINE (1) 0.85% X LINE (1) 8.92% X LINE (1) 0.90% X LINE (1) 526.08 (1) 40.25 (2) 273.20 (3) 14.94 (4) 23.67 (5) 4.47 (6) 46.93 (7) 4.73 (8) (9) 934.27 (10) 186.85 ( 1 1) $ 1,121.13 (12) INSURANCE, TAXES 109.04 (b) 0 INSURANCE (13) PAGE TAXES (14) TOTAL LINES (13) + (14) 10%XLINE (15) GRAND TOTAL FOR INSURANCE, TAXES: LINE (15) + (16) MATERIALS 109.04. (c) MATERIALS WEEK ENDING See Page 4 of 4 (ATTACH COPIES OF INVOICES) TOTAL MATERIALS 12% X LINE (18) GRAND TOTAL FOR MATERIALS: LINE (18) + (19) EQUIPMENT 109.04 (d) 400.00 (18) 48�.00� (19) 448.00 (20) CONTRACTOR OWNED S M T w T F S TOTAL RATE TOTAL 1 DIGGER DERRICK TRUCK Q 87.56 ' 2 BUCKET TRUCK 0- 51.05 - 3 SERVICE TRUCK -1 TON 8 8 22.35 178.80 TRENCHER,PLOW,HOE 4 COMBO Q 28.96 - TRUCK CRANE (13 TON) 5 W/DIGGER 0 123.95 AIR COMPRESSOR W TOOLS- s 185 HP o 13.Ss - 7 TRAILER 10 TON 0 4.24 - 8 POLE TRAILER - 8 TON 0 3•91 ' 9 BACKHOE 580 EXTEND -A -HOE 0139.25 ' 10 DUMP TRUCK 0 28.99 - 17 CONCRETE SAW, 65 HP 0 31.07 ' 12 LOOP TRUCK 0 22.35 - 13 BORING MACHINE 0 89.74 - 14 LDOP SEALANT HOT MELTER 0 30.69 - TOTAL CONTRACTOR OWNED EQUIPMENT 178.80 (21) RENTED EQUIPMENT (ATTACH DAILY COPIES OF INVOICES) - (22) FUEL, LUBRICANTS AND TRANSPORTATION COSTS (23) TOTAL LINES (21) + (22) + (23) 178.80 (24) 12% X LINE (24) 21.46 (25) GRAND TOTAL EQUIPMENT LINES (24) + (25) 200.26 (25) 0 Equipment Rental 109.04 (d) PAGE 3 OF 4 Equipment Rental Week Ending Item Description Qty Unit Rate Extension 2 _ 3 _ 4 _ 5 _ 6 - Subcontracts 109.04 (d) Rental Total - Item Subcontractor Amount 1 2 3 4 5 6 7 TOTAL SUBCONTRACT WEEK ENDING - (27) TOTAL SUBCONTRACT TO DATE - (28) 10% X LINE (28) $3,000 OR LESS - (29) 7% X LINE (28) OVER $3,000 FALSE (30) GRAND TOTAL SUBCONTRACT LINES (28) + (29) + (30) - (31) TOTAL LINES (12) (17) (20) (26) & (31) $ 1,769.38 (32) % OF BOND RATE BASED UPON LINE (32) - (33) 10% X LINE (33) - (34} TOTAL EXTRA WORK LINE (32) + (33) + (34) 1,769.38 (35) 0 MATERIALS 109.04 (c) PAGE 4 OF 4 Materials Item description Qty Unit Unit Price Extension 1 FlbeMlass Hand Hale 2 EACH 200.00 400.00 2 3 - 4 - 5 6 - 7 - 8 - 9 ` 10 - 12 - 13 14 r 16 - 17 ` 18 19 - 20 - MATERIAL TOTAL 400.00