OLCO Inc/Eng/CO5/Shared use Path Main Street (2)CITY OF CARMEL
TO: CONTRACT CHANGE ORDER NO.: 5
DATE: 6/5/15
PROJECT NAME: Shared Use Path Main Street
CITY REQ. NO.:
CITY PO NO.:
CITY PO DATE:
I. You are directed to make the following changes in this Contract:
Adjust Intermediate Completion Date due to delays imposed by the City of Carmel
SCHEDULED ADJUSTMENT
ITEM AMOUNT (+) OR (-) DAYS
II. The following referenced Documents further describe the changes outlined in -Paragraph I,
and are to be considered a part of this Change Order: R.F.P.: W.D.C. No.:
Other: INDOT Chance Order 5
The changes result in the following adjustment of Contract Price and Contract Time:
Contract Price prior to this Change Order $ 893 270.26
Contract Price will be increased/decreased by this Change Order $ 0.00
New Contract Price including this Change Order $_893.,270-26
Contract Time Prior to this Change Order Days 11/30/15 Intermediate Completion Date
Net increased/decreased resulting from this Change Order 47 Days
Current Contract Time including this Change Order Days 6/5/15 Intermediate
Completion Date
This Change Order is for full and. final settlement of all direct, indirect, impact costs and time
extensions incurred at any time resulting from the performance of the changed work.
The Above Changes Are
Recommended
CHA Companies
ENGINEER
300 S Meridian
Address
Indianapolis, In 46225
City/State/Zip
By:Thomas Gentry
Phone: 317-503-5250
Date: -6-5-15
The Above Changes Are
Accepted:
CONTRACTOR
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Address
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City/State/Zip
By:
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Phone: 231.433,QD5'
Date:
Approved:
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JEREMY KASHMAN
Contract No:R -36869 Change Order No.: 005
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -36869 Letting Date:08/06/2014
District:GREENFIELD DISTRICT AE:Nierman, Chad PE/S:Gregg, Michael Status:Pending
Change Order Information Change Order No.: 005 EWA: N or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00/00/0000
Reason Code: INCENTIVE/DISINCENT, Intermediate Compl
Description: Intermediate Completion Extension Due to Delays By Owner
Original Contract Amount $ 821,339.94
Current Change Order Amount $ 0.00 Percent: 0.000 %
Total Previous Approved Changes $ 71,930.32 Percent: 8.758 %
Total Change To -Date $ 71,930.32 Percent: 8.758 %
Modified Contract Amount $ 893,270.26
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
Previous Time Approved
SS Days 0 SP Days 0 SP Days Value $ 0.00
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 -36869
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.: 005
Page: 2
AE: DCE: SCE: I * DDCM:
(-LE$250K-)(-LE$750K-)(--LE$2M--)(—GT$2 M--)
( 50 SS days ) ( 100 SS days) ( 200 SS Days) ( GT 200 SS days)
Y / N If Y, by Date Issued
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
Date Returned
Date
Disapproved
Resolved by Date
LPA Signatures Required? Y / N If Y, Date to LPA 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 -36869 INDIANA Date: 10/05/2015
Change Order No:005 Department of Transportation Page: 3
Contract: R -36869
Project: State: 138316600LC3
Change Order Nbr: 005
Change Order Description: Intermediate Completion Extension Due to Delays By Owner
Reason Code: INCENTIVE/DISINCENT, Intermediate Compl
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
Total Value for Change Order 005 = $ 0.00
Milestone Time Adjustment
Milestone Nbr: 01
Milestone Description: INTERMEDIATE COMPLETION DATE
Original Completion dt: 11/30/2014 Adj comp) dt 06105/2015 Adj No. of Days 47
Explanation:
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 extends the intermediate completion date 47 day to June, 6th 2015. The delays are due to the Owner considering scope
changes during construction This disrupted the fabrication of materials need to complete construction causing further delays.
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.
Contractor: O�-Co,V Signed By: . Uv oGLy�
Date: A1 ��&Ok5
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NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Contract NOR -36869 INDIANA Datel 0/05/2015
Change Order No:005 Department of Transportation Page: 4
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APPROVED FOR LOCAL PUBLIC AGENCY
(SIGNATURE) (TITLE) (DATE)
(SIGNATURE) (TITLE) (DATE)
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SUBMITTED FOR CONSIDERATION
PENS
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
Project Engineer/Supervisor Gentry, Thomas 00/00/0000 Action Pending
Area Engineer Nierman, Chad 00/00/0000 Action Pending