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Home My Public Portal AboutChage Oreder No. 15 to Contract No. 148-2014 - INDOT Coordination Agreement (R-37463) 1382810 - Bike Pedestrian facilities1 I Contract No:R -37463 Change Order No.: 015 INDIANA Department of Transportation Page: 1 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 PE/S:Stanley, William 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: ERRORS & OMISSIONS, Item Related Description: Signal Mast Arm Extension Original Contract Amount $ 5,883,000.00 Current Change Order Amount $ 5,527.48 Percent: 0.094 % Total Previous Approved Changes $-30,119.55 Percent: -0.512 % Total Change To -Date $-24,592.07 Percent: -0.418 % Modified Contract Amount $ 5,858,407.93 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.: 015 Page: 2 AE: M.PrathebCE: SCE: * DDCM: (-LE$250K-)(-LE$750K-)(--LE$2M--)(--GT$2M--) ( 50 SS days) ( 100 SS days) ( 200 SS Days) ( GT 200 SS days) Y / N If Y, by G.Steins Date Issued 2/5/19 Y / N If Y, Copy to Program Budget Manager Y / N If Y, Referred to Project Manager(PM) Date to PM Approval Authority Concurs with PM? Y / N If Y, Concurrence by If N,Resolution: Approved Resolved Date Returned Date Disapproved Date LPA Signatures Required? Y / N If Y, Date to' LPA 4/29/19 Date Returned FHWA Signatures Required? Y / N If Y, Date to FHWA Date Returned, * Field Engineer Recommendation (Required for SCE or DDCM Approval) Field Engineer Date Comments: Contract No:R -37463 INDIANA Change Order. No:015 Department of Transportation Contract:. R:-37463 . Project: 1382810 - State138281000LC3 Change Order Nbr. .015 Change Order.Description: Signal Mast Arm Extension Reason Code: ERRORS &OMISSIONS, Item Related Date:04/M2019 Page: 3 CLN PCN .. PLN Item Code Unit Unit Price CO Oty, Comment Amount Change 0181- 1382810 0181 807-04940 EACH 5,527A80 1.000 C Amount:$ 5,527.48 Item Description: MAST ARM Supplemental Descriptionl: 10 LFT Extension Supplemental Description2: Total Value for Change Order 015 = $ 5,527.48 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 compensates the contractor for purchase and installation of a 10 LIFT Signal mast arm.extension at North A and 7th. Street. The designed length did not take into'consideration the additional length need to traverse the designated parking lane. Upon: further review.by the designer -of record, it was determined that the existing foundation and strain pole are of adequate size to support an extension of the placed mast arm. Since this.is a common component, the arm extension is readily available and easy, to place: The contractor has already performed this work and the signal is functioning as intended. INDOT traffic investigations engineer, Nathan'Sturdevant, PE also reviewed the signal. Milestone. and their subcontractor Drew, provided a cost breakdown summary and change order request for.which is attached to this CO as supporting documentation. Change Order Explanation for Specific Line Item 4t11111t•itfffi.ftlftflfff Rfllf•kffflfiNRlttrlt•f1f.t1f.f11tf.t1RlRRit.t•..t..Rttt•.tf.......... rt.ftitf.tr...... tt....... 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. Milestohe Contractors, L.P. Contractor: Signed B Date: �'T---3 C): /GO' faf.utttauf.afR.titfra.t.rf.ef rt.t.rf.lef rrf f f f nftfutfr.ftf.fuau.r• rtfu»R.uu.►u•• r..eaf taa............. ........ NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager.system. Contract NOR -37463 INDIANA Date:04/29/2019 Change Order No:015 Department of Transportation Page: 4 APPROVED FOR LOCAL PUBLIC AGENCY AP� (SIGNATURE) (TITLE) (DATE) - wlaQ (SIGNATURE) In in l�2 (TITLE) SUBMITTED FOR CONSIDERATION ****tiff*t#tt*##t#f+ki#i#f***ifiiY#i**4#*##itt#ttiiY*Yi*#Y*i*xiYYYi*ti+tfiiltiki*iitiitiif*i#it*****iit**it*ii*tit*#i**ti***i 9 (DATE) -` - C 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 February 21, 2019 PROJECT DESCRIPTION ENHANCEMENT, BIKE AND PEDESTRIAN FACILITIES, WAYNE COUNTY, ON E MAIN ST, 7T" ST AND 10T" ST IN THE CITY OF (route/intersection/bridgeno(s).J RICHMOND, IN CHANGE ORDER REQUEST SUMMARY DESCRIPTION PROPOSED SOLUTION SUMMARY MAST ARM EXTENSION JAMES H. DREW TO TO PERFORM WORK TO MAST ARM EXTENSION NOTE: Upon request from Engineer, enter detailed description on page 2. ONSET DATE OF CHANGE I January 10, 2019 CHANGE ORDER TYPE 104.03 Extra Work PROPOSED COST AND TIME ADJUSTMENT COST COST INCREASE / (DECREASE): $ S,S27.48 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 M 109.05(a) Agreed Price ❑ 109.05(b) Force Account ❑ 109.05.02 Delay Costs PROPOSED COST CHANGE INCLUDES: ❑ Labor ❑ Material ❑ Equipment ❑ Lease Agreement M Subcontractor TIME ADJUSTMENT INCREASE / (DECREASE): CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: (work days) 0 ❑ 108.08(a) Excusable, Non-Compensable ® 108.08(b) Excusable, Compensable NOTE: If Compensable, attach details based on 109.05.2(a) Allowable Delay Costs. SUPPLEMENTAL INFORMATION Additinnal infnrmatinn may be entered by the rnntrnrtnr_ CHANGE ORDER ORIGINATION: ❑ INDOT / LPA ® 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 ® no (if yes, attach details) 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 ADDITIONAL DETAIL January 10 2019 ADDITIONAL DETAIL [Select Date] DETAILED DESCRIPTION /JUSTIFICATION: (Include location(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.) OWNER REQUESTED TRAFFIC SIGNAL POLE ARM EXTENSION (ACROSS NORTH 'A' AND 7TH ST, US40 WEST) 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.) SUBCONTRACTOR, JAMES H DREW, TO PERFORM THE WORK FOR THE MAST ARM EXTENSION AT LOCATION SIGNATURES Contractor: Name: (print) SCOTT A. HESTER (signature) Date: 02/21/19 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) C h ri c M a l l Ar _D-N; cn=Chris Miller, o,ou, emall--chrls.mlller@ucindycom, Date: Date: 2019.042916U6:01 _"00- NOTE: The Contractor and PE/5 should retain a signed copy of this document for record. 4/29/19 UM CHANGE ORDER REQUEST FORM CONTRACT NO. R-37463-B ATTACHMENT: UNIT PRICE ITEMS DETAIL Attach or paste a unit price item detail. MAST ARM EXTENSION 1 LUMP SUM @ $5,527.48 = $5,527.48 WORK TO BE PERFORMED BY JAMES H DREW, SUBCONTRACTOR