HomeMy WebLinkAbout3D Company, Inc./ENG/$10,222.54/20-ENG-02 106th St and College Ave RAB - CO #4 DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
City of Carmel Project 20-ENG-02 _Pr-.
Intersection Improvements : 106th Street
and College Avenue Roundabout
CHANGE ORDER #4
This change order will add pay items for a yard drain on the property on the northwest corner of Arthur
Drive and College Avenue;additional water main work at 106th and Broadway intersection; downtime
for rental materials for STR 125A; and payment for materials due to deletion of STR 174 and STR 176 on
the east leg of the project; and a liquidated damages pay item. There is no time extension for this work.
This change order will also adjust the substantial and final completion dates. The substantial completion
date is changing from December 2, 2022 to March 31,2023. The final completion date is changing from
January 3, 2023 to June 2,2023.
Contract Price prior to this Change Order $3,804,245.77
Contract Price will be changed by this Change Order $10,222.54
New Contract Price including this Change Order $3,814,458.31
Amount Adjusted Contract Cumulative%Change
Price from Original Contract
Original Contract $3,660,000.00 N/A N/A
CO1 $99,360.21 $3,759.360.21 2.71%
CO2 $21,026.40 $3,780,396.61 3.29%
CO3 $23,849.16 $3,804,245.77 3.94%
C04 $10,222.54 $3,814,458.31 4.22%
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CITY OF CARMEL
TO: Jeremy Kashman CONTRACT CHANGE ORDER NO.: 4
City Engineer DATE: October 17,2023
City of Carmel Indiana PROJECT NAME: 106th and College Ave RAB
One Civic Square CITY REQ. NO.:
Carmel, IN 46032 CITY PO NO.: 20-ENG-02
CITY PO DATE:
I. You are directed to make the following changes in this Contract:
This change order will add pay items for a yard drain on the property on the northwest corner of Arthur Drive
and College Avenue; additional water main work at 106th and Broadway intersection;downtime for rental
materials for STR 125A; payment for materials due to deletion of STR 174 and STR 176 on the east leg of
the project;and a liquidated damages pay item. There is no time extension for this work. This change order
will also adjust the substantial and final completion dates. The substantial completion date is changing from
December 2,2022 to March 31,2023. The final completion date is changing from January 3,2023 to June
2,2023.
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.: N/A W.D.C.NO.: N/A
The changes result in the following adjustment of Contract Price and Contract Time:
Contract Price prior to this Change Order $ 3,804,235.77
Contract Price will be increased by this Change Order $ 10,222.54
New Contract Price including this Change Order $ 3,814,458.31
Contract Time prior to this Change Order Days Closure 12/2/2022 Substantial Completion Date
Contract Time prior to this Change Order 1/3/2023 Final Completion Date
Net increased/decreased resulting from this Change Order Days
Current Contract Time including this Change Order Days Closure 3/31/2023 Substantial Completion Date
Current Contract Time including this Change Order 6/2/2023 Final 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 The Above Changes Are Accepted Approved
Recommended
American StructurenoinL Inc. 3D Company,Inc. Not Present
ENGINEER CONTRACTOR James Brainard,Mayor
�ooisea Uy:
9025 River Road.Suite 200 7240 North State Road 3 haini 1l th. I.
Address Address M ari.�ai cco
iiri Burke,Member
o
Indianapolis.IN 46240 Muncie,IN 47303 ten (1i i-sw.
City/State/Zip City/State/Zip �dfi�zz3aea:aaoo
Lort Watson,Member
Jer y Kashman,PE, testy Engineer
By: D cL��2%eAoJ By: �s, sv�C���
ATTES,T.:DocuSigned by:
Phone: 317-281-9563 Phone: (765)288-3326 wdlc
Sue Wolfg ;°ettk
Date: 11/1/2023
Date: October 17,2023 Date: October 23,2023
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CITY OF CARMEL
TO: CONTRACT CHANGE REQUEST NO.: 32
DATE: 8/1/23
PROJECT NAME: 106th St& College Ave. RAB
FROM: 3D Company Inc.
IT IS REQUESTED THAT A CONTRACT CHANGE BE MADE TO THE ABOVE
REFERENCED CONTRACT.
1. SCOPE OF WORK(USE ADDITIONAL PAGES IF REQUIRED. ALSO LIST OTHER
CONTRACTS INVOLVED.)
Installation of yard drain at College and Arthur.
2. REASON FOR CHANGE:
Installation of yard drain was unforeseen and needed to aid in drainage at this intersection.
3. APPROXIMATE COST CHANGE TO CONTRACT PRICE: $1,530.66
4. WILL THE CONTRACT NEED ADDITIONAL CONTRACT TIME TO COMPLETE
THE CHANGE IN WORK SCOPE? x -YES -NO .5 -(CALENDAR
DAYS)
5. WILL THE CONTRACTOR NEED ADDITIONAL PERSONNEL TO COMPLETE THE
CHANGE IN WORK SCOPE? -YES X -NO
IF NO, TRADE(S):
NO. OF PERSONNEL:
DURATION:
6. IDENTIFICATION OF ATTACHMENTS:
COR#32 is attached.
DATE: DATE:
PREPARED
REVIEWED BY: Seth Blalock REVIEWED BY:
ENGINEER
Comments and Recommendation:
AR-5
Version 2018-12-19
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02 DATE OF SUBMISSION 8/1/23
PROJECT DESCRIPTION 106th Street and College Avenue Roundabout
(route/intersection/bridge no(s).)
CHANGE ORDER REQUEST SUMMARY Installation of yard drain at College and Arthur intersection.
DESCRIPTION
PROPOSED SOLUTION SUMMARY Installation of yard drain and connection into newly installed storm system.
NOTE:Upon request from Engineer, enter detailed description on page 2.
ONSET DATE OF CHANGE 5/24/23 CHANGE ORDER TYPE 104.03 Extra Work
PROPOSED COST AND TIME ADJUSTMENT
COST COST INCREASE/(DECREASE): $ 1,530.66
The cost adjustment shall include lump sum and/or 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 ❑
Subcontractor
Click here to
TIME ADJUSTMENT INCREASE/(DECREASE): (work days) enter text.
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
►Z1 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
Additional information.
CHANGE ORDER ORIGINATION: ® Owner/Inspection 0 Contractor
DOCUMENTS AFFECTED:
® Contract Specifications(ref.doc name/no.) INDOT Standard Specifications 2020
❑ Contract Plans(ref.doc name/no.) Intersection Improvements 106th Street&College Ave. RAB 20-ENG-02
CHANGE ORDER AFFECTS DBE PARTICIPATION: ❑yes ® no (if yes,attach details)
Ver 1018.18
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL
DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF
ADDITIONAL DETAIL [Select Date] [Select Date]
ADDITIONAL DETAIL
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.)
Installation of yard drain at intersection of College and Arthur.
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.)
Installation of yard drain and connection into newly installed storm system.
SIGNATURE
Contractor: 3D Company Inc.
Name: (print eanna D.Case
(signature) k C C\ . C_CZI)RI__ Date: 8/1/23
NOTE: The Contractor should retain a signed copy of this document for record.
pg. 2
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
ATTACHMENT: UNIT PRICE ITEMS DETAIL
Attach or paste a unit price item detail.
See attached force account sheet for breakdown of cost.
pg. 3
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
T&M Spreadsheet
INDOT Contract#: 20-ENG-02 Contract Descp:
Prime Contractor: 3D Company Inc. Subcontractor:
Date Work Performed: 5/24/2023 Inspector:
T&M Task Description:Installation of yard drain and connection at College and Arthur. 7 yards
of top soil were placed for this work and the AT&T relocation.
Labor(includes Fringes & Applicable Taxes)
O.H. &
Name Classification Rate/Hour Hours Subtotal Profit Amount
1 Foreman $94.00 3.00 $282.00 1.20 $338.40
2 Laborer $62.00 3.00 $186.00 1.20 $223.20
3
4
5
Labor Total: $561.60
Equipment
O.H. &
Make Classification Rate/Hour Hours Subtotal Profit Amount
1 Kubota 95 Skidsteer $147.00 3.00 $441.00 1.12 $493.92
2 Ford F-550 Single Axle Dump $115.00 2.00 $230.00 1.12 $257.60
3
4
5 6
Equipment Total: $751.52
Materials (See Attached invoices)
O.H. &
Description _ Location Unit Price Quantity Subtotal Profit Amount
1 Yard Drain/Pipe $128.29 1.00 $128.29 1.12 $143.68
2 Hydralic Cement $21.98 3.00 $65.94 1.12 $73.85
3
4
Material Total: $217.54
Sub Contractors
O.H. &
Subcontractor Type Unit Price Quantity Subtotal Profit Amount
1
Material Total: $0.00
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
Daily Cost Summary Signature:
Prime Contractor
Daily Labor Total: $561.60
Daily Equipment Total: $751.52 Signature:
Daily Materials Total: $217.54 Inspector
Subcontractor Total: $0.00
Bond %Increase Total: Signature:
GC (10%-1st$3,000): Subcontractor
GC (7%-Over$3,000):
Daily Grand Total: $1,530.66 Signature:
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CITY OF CARMEL
TO: CONTRACT CHANGE REQUEST NO.: 04
DATE: 2/27/2023
PROJECT NAME:
FROM: 3D Company Inc.
IT IS REQUESTED THAT A CONTRACT CHANGE BE MADE TO THE ABOVE
REFERENCED CONTRACT.
1. SCOPE OF WORK(USE ADDITIONAL PAGES IF REQUIRED. ALSO LIST OTHER
CONTRACTS INVOLVED.)
„est for change order due to change of snpe of work.for
water main tie at Rrnadway & 106th intersection_
2. REASON FOR CHANGE:
Chane in scope of work.
3. APPROXIMATE COST CHANGE TO CONTRACT PRICE: $ 3,631.68
4. WILL THE CONTRACT NEED ADDITIONAL CONTRACT TIME TO COMPLETE
THE CHANGE IN WORK SCOPE? X -YES -NO 1 -(CALENDAR
DAYS)
5. WILL THE CONTRACTOR NEED ADDITIONAL PERSONNEL TO COMPLETE THE
CHANGE IN WORK SCOPE? -YES X -NO
IF NO, TRADE(S):
NO. OF PERSONNEL:
DURATION:
6. IDENTIFICATION OF ATTACHMENTS:
time and materials force account breakdown attached along with material
invoices.
DATE: 2/27/2023 DATE:
PREPARED
REVIEWED BY: Seth Blalock REVIEWED BY:
ENGINEER
Comments and Recommendation:
AR-5
Version 2018-12-19
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
February 27,
CONTRACT NO. 20-ENG-02 DATE OF SUBMISSION 2023
PROJECT DESCRIPTION 106'h Street and College Avenue Roundabout
(route/intersection/bridge no(s).)
CHANGE ORDER REQUEST SUMMARY Change of scope for watermain tie-in at Broadway & 106'h intersection
DESCRIPTION
PROPOSED SOLUTION SUMMARY Click here to enter text.
NOTE:Upon request from Engineer, enter detailed description on page 2.
ONSET DATE OF CHANGE October 28, 2022 CHANGE ORDER TYPE 104.03 Extra Work
PROPOSED COST AND TIME ADJUSTMENT
COST COST INCREASE/(DECREASE): $ $3,631.68
The cost adjustment shall include lump sum and/or 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 ❑
Subcontractor
TIME ADJUSTMENT INCREASE/(DECREASE): (work days) 1
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
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
Additional information.
CHANGE ORDER ORIGINATION: ® Owner/Inspection 0 Contractor
DOCUMENTS AFFECTED:
® Contract Specifications(ref.doc name/no.) INDOT Standard Specifications 2020
❑ Contract Plans(ref.doc name/no.) Intersection Improvements 106th Street&College Ave. RAB 20-ENG-02
CHANGE ORDER AFFECTS DBE PARTICIPATION: yes ❑ no (if yes,attach details)
Ver. 10.18.18
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL
DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF
ADDITIONAL DETAIL [Select Date] [Select Date]
ADDITIONAL DETAIL
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.)
Click here to enter text.
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.)
3D was instructed by onsite inspector on how to proceed.
SIGNATURE
Contractor: 3D Company Inc.
Name: (print) eanna D. Case
(signature) t Y' h Date: 2/27/2023
NOTE: The Contractor should retain a signed copy of this document for record.
pg. 2
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
ATTACHMENT: UNIT PRICE ITEMS DETAIL
Attach or paste a unit price item detail.
See attached force account sheet for breakdown of cost involved.
p9
. 3
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
fd FERGUSON' INVOICE NUMBER TOTAL DUE CUSTOMER PAGE
WATERWORKS 0297710 $2,279.22 14225 , 1 of 1
2126 WEST 400 SOUTH PLEASE REFER TO INVOICE NUMBER WHEN
KOKOMO, IN 46902-9615 MAKING PAYMENT AND REMIT TO:
C py t) PO E BOX ON
5ATERWORKS#1934
644
Please contact with Questions: 317-546-2013 PITTSBURGH,PA 15264-4054
;.i.T 9 A2.0 r
I
F SHIP TO:
3D COMPANY INC
106TH AND COLLEGE
3D COMPANY INC 106TH&COLLEGE AVE
ifireti:
7240 N SR 3 CARMEL, IN 46032
106TH&COLLEGE AVE
MUNCIE,IN 47303
SHIP SELL TAX CODE CUSTOMER ORDER NUMBER SALESMAN JOB NAME INVOICE DATE BATCH
WHSE, WHSE.
10
2930 2930 INE 2563 LMA 106TH&COLLEGE AVE 10/25/22 24424
ORDERED SHIPPED ITEM NUMBER DESCRIPTION UNIT PRICE UM AMOUNT
1 1 DMJTLAI6U DOM 16X6 MJ C153 TEE UA 1099.510 EA 1099.51
2 2 DMJLSLAU DOM 6X12 MJ C153 LONG SLV UA 158.000 EA —316r.96
1 1 AFC2506MMLAOR 6 DI MJ RW OR GATE VLV UA 863.710 EA 863.71
INVOICE SUB-TOTAL 2279.22
LEAD LAW WARNING:IT IS ILLEGAL TO INSTALL PRODUCTS THAT ARE NOT"LEAD FREE'IN ACCORDANCE WITH
US FEDERAL OR OTHER APPLICABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION
PRODUCTS W TM"NP IN THE DESCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN
NON-POTABLE APPLICATIONS.BUYER IS SOLELY RESPONSIBLE FOR PRODUCT SELECTION.
Looking for a more convenient way to pay your bill? -
0
.ta;
Log in to Ferguson.com and request access to Online Bill Pay. _ -.
I s
TERMS: NET 10TH PROX ORIGINAL INVOICE TOTAL DUE $2,279.22
All past due amounts are subject to a service charge of 1.5%per month,or the maximum allowed by law,if lower.if Buyer falls to pay within terms,lthen in
addition to other remedies,Buyer agrees to pay Seller all costs of collection,including reasonable attorney fees.Complete terms and conditions are vailable
upon request or at https:Nwww.ferguson.comicontent/website-info/terns-of-sale,incorporated by reference.Seller may convert checks to ACH.
'Any reference to or incorporation of Executive Order 14042 and/or the EO-implementing Federal clauses(FAR 52.223-99 and/or DFARS 252.223-7999 's
expressly rejected by Seller and shall not apply as Seller is a materials supplier and therefore exempt under the Executive Order.'
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
Time & Materials Spreadsheet
INDOT Contract*: 20-ENG-02 Contract Descp: 106th St&College RAB
Prime Contractor: 3D Company Subcontractor:
Date Work Performed: 10/28/2022-11/01/22 Inspector: Dave Machala
T&M Task Description: Change of scope for water main tie at Broadway&106th intersection.
T&M Task Provider(Prime or Subcontractor):
Weather Conditions: Task Start Time:
Task Finish Time:
Comments:
Labor(Includes Fringes&Applicable Taxes)
O.H.&
Name Classification Rate/Hour Hours Subtotal Profit Amount
1 Chris Petty Foreman $74.24 3.00 $222.72 1.20 $267.26
2 Nathan Cox Laborer $52.35 3.00 _$157.05 1.20 $188.46
3 Joseph Futrell Laborer $52.35 3.00 $157.05 1.20 $188.46
4 Brennen Hess Operator $69.70 3.00 $209.10 1.20 $250.92
5
Labor Total: $895.10
Equipment
O.H.&
Make Classification Rate/Hour Hours Subtotal Profit Amount
1 Case 235C Exc.56,000 lb $109.16 3.00 $327.48 1.12 $366.78
2 Cat 914K Wheel Loader 1.5 YD $50.89 3.00 $152.67 1.12 $170.99
3
4 _
6
Equipment Total:' $537.77
Materials(See Attached Invoices)
O.H.&
Description Supplier Unit Price Quantity Subtotal Profit Amount
I Fittings,Gaskets,Etc Ferguson $1,963.22 1.00 $1.963.22 1.12 $2,198.81
2
Material Total: $2,198.81
Signature:
Daily Cost Summary Prime Contractor
Daily Labor Total: $895.10 Signature:
Daily Equipment Total: $537.77 Inspector
Daily Materials Total: $2,198.81
Bond%Increase Total: Signature:
GC(10%-1st$3,000): Subcontractor
GC(7%-Over$3,000):
Daily Grand Total: $3,631.68 Signature:
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CITY OF CARMEL
TO: CONTRACT CHANGE REQUEST NO.: 07
DATE: 1/11/2023
PROJECT NAME: 106th St & College Ave. RAB
FROM: 3D Company Inc.
IT IS REQUESTED THAT A CONTRACT CHANGE BE MADE TO THE ABOVE
REFERENCED CONTRACT.
1. SCOPE OF WORK(USE ADDITIONAL PAGES IF REQUIRED. ALSO LIST OTHER
CONTRACTS INVOLVED.)
Downtime for utility delays with Duke and AT&T at structure 125A.
2. REASON FOR CHANGE:
Multiple utility conflicts
3. APPROXIMATE COST CHANGE TO CONTRACT PRICE: $3,864.00
4. WILL THE CONTRACT NEED ADDITIONAL CONTRACT TIME TO COMPLETE
THE CHANGE IN WORK SCOPE? X -YES -NO 3 -(CALENDAR
DAYS)
5. WILL THE CONTRACTOR NEED ADDITIONAL PERSONNEL TO COMPLETE THE
CHANGE IN WORK SCOPE? -YES X -NO
IF NO, TRADE(S):
NO. OF PERSONNEL:
DURATION:
6. IDENTIFICATION OF ATTACHMENTS:
time and materials force account breakdown attached.
DATE: 1/11/2023 DATE:
PREPARED
REVIEWED BY: Deanna Case REVIEWED BY:
ENGINEER
Comments and Recommendation:
AR-5
Version 2018-12-19
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
January 11,
CONTRACT NO. 20-ENG-02 DATE OF SUBMISSION 2023
PROJECT DESCRIPTION 106th Street and College Avenue Roundabout
(route/intersection/bridge no(s).)
CHANGE ORDER REQUEST SUMMARY Downtime for utility delays with Duke and AT&T at structure 125A.
DESCRIPTION
PROPOSED SOLUTION SUMMARY Click here to enter text.
NOTE:Upon request from Engineer, enter detailed description on page 2.
ONSET DATE OF CHANGE September 27, 2022 CHANGE ORDER TYPE 104.02 Changed Conditions
PROPOSED COST AND TIME ADJUSTMENT
COST COST INCREASE/(DECREASE): $ 3,864.00
The cost adjustment shall include lump sum and/or 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 1Z1 109.05(b)Force Account ❑ 109.05.02 Delay Costs
PROPOSED COST CHANGE INCLUDES: ❑ Labor ❑ Material El Equipment ❑ Lease Agreement ❑
Subcontractor
TIME ADJUSTMENT INCREASE/(DECREASE): (work days) 3
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
❑ 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
Additional information.
CHANGE ORDER ORIGINATION: [Si Owner/Inspection ❑ Contractor
DOCUMENTS AFFECTED:
® Contract Specifications(ref.doc name/no.) INDOT Standard Specifications 2020
❑Contract Plans(ref.doc name/no.) Intersection Improvements 106th Street&College Ave. RAB 20-ENG-02
CHANGE ORDER AFFECTS DBE PARTICIPATION: ®yes ❑ no (if yes,attach details)
Ver 10 18.18
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL
DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF
ADDITIONAL DETAIL [Select Date] 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.)
Downtime for utility delays with Duke and AT&T at structure 125A.
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.)
3D was instructed by onsite inspector on how to proceed.
SIGNATURE
Contractor: 3D Company Inc.
Name: (print) eanna D. Case
(signature) t ����r�SL Date: 1/11/2023
NOTE: The Contractor should retain a signed copy of this document for record.
pg. 2
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
ATTACHMENT: UNIT PRICE ITEMS DETAIL
Attach or paste a unit price item detail.
See attached force account sheet for breakdown of cost involved.
pg. 3
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
Change Order Spreadsheet
INDOT Contract#: 106th&College RAB Contract Descp:
Prime Contractor: 3D Subcontractor:
Date Work Performed: 9/27/2022-9/29/2022 Inspector: Dave Machala
T&M Task Description: Downtime for utility delays with Duke and AT&T at structure 125A.
T&M Task Provider(Prime or Subcontractor):
Weather Conditions: Task Start Time:
Task Finish Time:
Comments:
Labor(Includes Fringes &Applicable Taxes)
O.H.&
Name Classification Rate/Hour Hours Subtotal Profit Amount
1
3
6
Labor Total: $0.00
Equipment
O.H.&
Make Classification Rate/Hour Hours Subtotal Profit Amount
1 Trench Box $2.550.00 1.00 $2,550.00 1.12 $2,856.00
2 Manhole Box $900.00 1.00 $900.00 1.12 $1,008.00
6
Equipment Total:I $3,864.00
Materials(See Attached Invoices)
1,0.H.&
Description Location Unit Price Quantity Subtotal Profit Amount
1
2
3
Material Total: $0.00
Sub Contractors
O.H.&
Subcontractor _Type Unit Price Quantity Subtotal - Profit Amount
1
2
6
Material Total: $0.00
Daily Cost Summary Signature:
Prime Contractor
Daily Labor Total:I $0.00
Daily Equipment Total:i $3,864.00 Signature:
Daily Materials Total: $0.00 Inspector
Subcontractor Total: $0.00
Bond%Increase Total: Signature:
GC(10%-1st$3,000): Subcontractor
GC(7%-Over$3,000):
Daily Grand Total: $3,864.00 Signature:
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
0 T H f 8686 BROOKVILLE RD
Rental INDIA17--7US, IN 791-2323 46239
3
S T 0 0 [
MacAllister Rentals Contract No. Invoice No. ' Date R-E C I T T)
Please Remit Your Payment to: 48249 5 R71482495501 28SEP2022
MacAllister Rentals ';,,,'
Dept. 78731
P.O. Box 78000 Page 1
Detroit, MI 48278-0731 4 WEEK INVOICE
6:39 PM
Late'o tixt a Date in
6866305 125EP2022 12:58 PM 100CT2022
3D COMPANY I NC 7 NumberI, Purchase Order7240 N STATE ROAD 3
MUNC I E, I N 47303 106TH AND COLLEGE 2563
Jab Location I Ordered by
Phone: 765-288-3326 108 AND COLLEGE, IHDIAHAPOLIS SETH 765 730 1831
Cell: 765-288-3326 CYCLE BILL 000208
Qty Equipment # Min Day Week I 4 Week Amount
1 4" X 8' X 20' TRENCH BOX 350.00 350.00 800.00 2200.00 2200.00
B4B2056 Make: EFFICIENCY Model: XLD-620 Ser #: 165239
1 4" X 4' X 20' TRENCH BOX 350.00 350.00 600.00 1700,00 1700.00
B442020 Make: EPI Model: XLD-420 Ser It 160714
8 8" X 5' SPREADERS 50.0C 50.00 100.00 150.00 1200.00
4 TRENCH BOX STACKING PINS 10.00 10.00 20.00 25.00 100.00
16 2" TRENCH BOX SPREADER PINS W 10.00 10.00 20.00 25.00 400.00
SALES ITEMS:
Qty Item number Unit Price
1 I NEX EA 129.713 129.71
INDIANA RENTAL EXCISE TAX
1 ENVIRONMENTAL FEE EA 19.000 19.00
ENVIRONMENTAL FEE
DELIVERY CHARGE 165.00
Pi
111
BILLED FOR FOUR WEEKS 9/12/22 THRU 10/10/22 12:58 PM ek42,,,J--
Sub-totaG- 59 1 �_1
BILLED FOR FOUR WEEKS 9/12/22 THRU 10/10/22 12:58 PM INDIANA STATE SALES TAX 404.88 `�
Total . . \s r
„,..,—.....",,,,,,
( 1 ic5\q,,F. )0(\.
IMPORTANT! Please note and acknowledge safety instruction by initialing here: Y------ --''''. I
By his/her Initial.Lessee will provide All safety accessories as required,per safety instructions.Initial here: — L'4'�""
PAYMENT: Nat-30 days from invoice date unless otherwise specified herein.A service charge will apply to all past due accounts.
RENTAL EQUIPMENT PROTECTION PLAN("REP"): Lessee will purchase REP(terms at www.macallister.com/rep and incorporated herein by reference)if Lessee fails to obtain insurance
coverage and provide MacAllister with proof of such coverage or if such insurance contains coverage amounts that are inadequate to cover the Equipment al any time.
TERMS AND CONDITIONS:The rental agreement terms and conditions found at www.macallister.com/rentallerms("Rental Terms")are incorporated herein by this reference and apply to your
rental of Equipment from or provision of Services by MacAllister(as defined in the Rental Terms).Reese read carefully.This agreement includes an indemnification clause,a Jury waiver,warranty
disclaimers,and limitations of MacAllister's liability.By accepting delivery of or using the Equipment or Services or making payment(s)to MacAllister for the same,Lessee agrees to be bound by the
Rental Terms and REP Terms,even if this Rental Out form has not been fully executed.
ACCEPTED BY CUSTOMER
MOM (290tt2920) -
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CITY OF CARMEL
TO: CONTRACT CHANGE REQUEST NO.: 29
DATE: 3/28/2023
PROJECT NAME: 106th St & College Ave. RAB
FROM: 3D Company Inc.
IT IS REQUESTED THAT A CONTRACT CHANGE BE MADE TO THE ABOVE
REFERENCED CONTRACT.
1. SCOPE OF WORK(USE ADDITIONAL PAGES IF REQUIRED. ALSO LIST OTHER
CONTRACTS INVOLVED.)
Structures 174& 176 were submitted, approved, produced, and then deleted
from the contract. 3D is requesting compensation for the material costs.
2. REASON FOR CHANGE:
Existing AT&T utilities were in conflict with the proposed locations of str's 174& 176.
Existing str's were used to avoid relocating utilities which deleted the proposed str's.
3. APPROXIMATE COST CHANGE TO CONTRACT PRICE: $1195.20
4. WILL THE CONTRACT NEED ADDITIONAL CONTRACT TIME TO COMPLETE
THE CHANGE IN WORK SCOPE? -YES X -NO -(CALENDAR
DAYS)
5. WILL THE CONTRACTOR NEED ADDITIONAL PERSONNEL TO COMPLETE THE
CHANGE IN WORK SCOPE? -YES X -NO
IF NO, TRADE(S):
NO. OF PERSONNEL:
DURATION:
6. IDENTIFICATION OF ATTACHMENTS:
COR#29 is attached.
DATE: 3/28/2023 DATE:
PREPARED
REVIEWED BY: Seth Blalock REVIEWED BY:
ENGINEER
Comments and Recommendation:
AR-5
Version 2018-12-19
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02 DATE OF SUBMISSION 3/28/2023
PROJECT DESCRIPTION 106th Street and College Avenue Roundabout
(route/intersection/bridge no(s).)
CHANGE ORDER REQUEST SUMMARY Structures 174 & 176 were submitted, approved, produced, and then
DESCRIPTION deleted from the contract. Reason for deletion was existing AT&T utilities
were in conflict with the proposed locations.
PROPOSED SOLUTION SUMMARY 3D is requesting compensation for the material costs.
NOTE:Upon request from Engineer, enter detailed description on page 2.
ONSET DATE OF CHANGE CHANGE ORDER TYPE 104.03 Extra Work
PROPOSED COST AND TIME ADJUSTMENT
COST COST INCREASE/(DECREASE): $ 1195.20
The cost adjustment shall include lump sum and/or 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 /l 109.05(b) Force Account ❑ 109.05.02 Delay Costs
PROPOSED COST CHANGE INCLUDES: ❑ Labor Material ❑ Equipment ❑ Lease Agreement ❑
Subcontractor
Click here to
TIME ADJUSTMENT INCREASE/(DECREASE): (work days) enter text.
CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE:
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
Additional information.
CHANGE ORDER ORIGINATION: ® Owner/Inspection 0 Contractor
DOCUMENTS AFFECTED:
® Contract Specifications(ref.doc name/no.) INDOT Standard Specifications 2020
❑ Contract Plans(ref.doc name/no.) Intersection Improvements 106th Street&College Ave. RAB 20-ENG-02
CHANGE ORDER AFFECTS DBE PARTICIPATION: ❑yes ® no (if yes,attach details)
Ver.10.18.18
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL DETAIL
DATE RECEIVED REQUEST FOR SUBMITTAL DATE OF
ADDITIONAL DETAIL [Select Date] [Select Date]
ADDITIONAL DETAIL
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.)
Structures 174& 176 were submitted,approved, produced,and then deleted from the contract. Reason
for deletion was existing AT&T utilities were in conflict with the proposed locations.
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.)
Existing structures were used to avoid timely utility relocations.This resulted in the deletion of str. 174
and 176.
SIGNATURE
Contractor: 3D Company Inc.
Name: (print) eanna D. Case
(signature) U 1 Date: 3/28/2023
NOTE: The Contractor should retain a signed copy of this document for record.
pg. 2
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
CHANGE ORDER REQUEST FORM
CONTRACT NO. 20-ENG-02
ATTACHMENT: UNIT PRICE ITEMS DETAIL
Attach or paste a unit price item detail.
See attached force account sheet for breakdown of cost.
P9. 3
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
Change Order Spreadsheet
INDOT Contract#: 20-ENG-02 Contract Descp: 106th St&College RAB
Prime Contractor: 3D Company Inc. Subcontractor:
Date Work Performed: Inspector: Dave Machala
T&M Task Description: Strucutres were submitted,approved,made,and then deleted from the
contract.
T&M Task Provider(Prime or Subcontractor):
Weather Conditions: Task Start Time:
Task Finish Time:
Comments:
Labor(Includes Fringes&Applicable Taxes)
O.H.&
Name Classification Rate/Hour Hours Subtotal Profit Amount
1 1.20 $1.20
2 1.20 $1.20
_
3
4
5
Labor Total: $2.40
Equipment
O.H.&
Make Classification Rate/Hour Hours Subtotal Profit Amount
1- $0.00 1.12 $0.00
2 $0.00 1.12
Equipment Total: $0.00
Materials(See Attached Invoices)
O.H.&
Description Location Unit Price Quantity Subtotal Profit Amount
1 Str.174 $570.00 1.00 $570.00 1.12 $638.40
2 Str.176 $495.00 1.00 $495.00 1.12 $554.40
Material Total: $1,192.80
Sub Contractors
O.H.&
Subcontractor Type Unit Price Quantity Subtotal Profit Amount j
1 $0.00 1.07 $0.00
2
Material Total: $0.00
Daily Cost Summary Signature:
Prime Contractor
Daily Labor Total: $2.40
Daily Equipment Total: $0.00 Signature:
Daily Materials Total: $1,192.80 Inspector
Subcontractor Total: $0.00
Bond%Increase Total: Signature:
GC(10%-1st$3,000): Subcontractor
GC(7%-Over$3,000):
Daily Grand Total: $1,195.20 Signature:
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
INVOICE
09 � � •(800)289-2569 Fax:(715)443-3768
P.O.BOX 100 SHIPPED INVOICE DATE ORDER NO.
MATERIALS C Q R P O R AT I O H MARATHON,W 154448-0100 10/15/22 10/17/22 3832786-00
P.O.NO. PAGE#
57 jh01 2563-5 L1 of 1
cusr#: 150010
106TH ST&COLLEGE AVE RAB v.','''°a 17-
SHIP TO: *0089-22*CHRIS 765-748-1328 -
NEAR 10602 E 106TH ST
CARMEL IN 46280
3D COMPANY INC
7240 NORTH STATE RD 3
BILL TO: MUNCIE IN 47303 e
LINE PRODUCT QTY. QTY. UNIT AMOUNT
NO. AND DESCRIPTION SHIPPED UIM . PRICE (NET)
1 sp057-0089-22-006 1.00 EA 570.00 570.00
STR#131 17X30(R13) INLET
2 sp057-0089-22-013 1.00 EA 570.00 570.00
STR#167 17X30(R13)INLET
3 sp057-0089-22-014 1.00 EA 570.00 570.00
STR# 169 17X30(R13) INLET
4 sp057-0089-22-015r 1.00 EA 570.00 570.00
„AIN,F II I it l\J'U II11ay IIVL.I
sp057-0089-22-016 1.00 EA 570.00 570.00
STR# 174 17X30(R13)INLET
�e-tltitar-21-vz, 595.00
STR# 168 17X30(MOD R13) INLET
7 sp057-0089-22-022 1.00 EA 595.00 595.00
STR# 175 17X30(MOD R13)INLET
8 sp057-0089-22-027 1.00 EA 495.00 495.00
STR# 126 24X36(J10)INLET
9 sp057-0089-22-033 1.00 EA 495.00 495.00
STR# 154 24X36(J10)INLET
10 sp057-0089-22-034 1.00 EA 495.00 495.00
STR#159 24X36(J10)INLET
11 78173006RIN 2.00 EA 0.00 0.00
INLET RISER 17"X 30" 6"TALL
12 78243606RIN 2.00 EA 0.00 0.00
INLET RISER 24"X 36"6"TALL
13 700250 4.00 ROLL 0.00 0.00
JT SEAL 3/4"X 14.5'(8/CASE)
Total 5525.00
Invoice Total 1„5_525.0n
ob
DocuSign Envelope ID:04372EEB-5867-4A05-9261-64610CF6A961
INVOICE
9 COUNTY.(800)289-2569 Fax:(715)443-3768 -
P.O.BOX 100 SHIPPED INVOICE DATE ORDER NO.
MATERIALS CORPORATION MARATHON,WI 54448-0100 10/14/22 10/14/22 3832788-00
P.O.NO. PAGE#
57 JHOL 2563-5 1 of 1
CUST#: 150010
106TH ST&COLLEGE AVE RAB R I�
r.L"`SHIP TO: *0089-22*CHRIS 765-748-1328 �V`
NEAR 10602 E 106TH ST
CARMEL IN 46280
3D COMPANY INC
7240 NORTH STATE RD 3
BILL TO: MUNCIE IN 47303
Allio
6117
LINE PRODUCT QTY. QTY. UNIT AMOUNT
NO. AND DESCRIPTION SHIPPED UM PRICE (NET)
1 sp057-0089-22-035 1.00 EA 495.00 495.00
STR#163 24X36(J10) INLET
2 sp057-0089-22-036 1.00 EA 495.00 495.00
OTii// 170 21)(30 (JIID)IPPLIiT
3 sp057-0089-22-037 1.00 EA 495.00 495.00
STR# 176 24X36(J10) INLET
..,007 0003 EC 041..; - I.uu to gcu.0 450.00
STR# 155 24X36(M10)INLET
5 sp057-0089-22-046 1.00 EA 450.00 450.00
STR# 156 24X36(M10)INLET
6 sp057-0089-22-047 1.00 EA 450.00 450.00
STR# 157 24X36(M10) INLET
7 sp057-0089-22-049 1.00 EA 450.00 450.00
STR#172 24X36(M10) INLET
8 sp057-0089-22-054 1.00 EA 575.00 575.00
STR#160 24X36(MOD M10)INLET
9 sp057-0089-22-055 1.00 EA 575.00 575.00
STR# 164 24X36(MOD M10)INLET
10 78243606RIN 9.00 EA 0.00 0.00
INLET RISER 24"X 36"6"TALL
11 700250 9.00 ROLL 0.00 0.00
JT SEAL 3/4"X 14.5'(8/CASE)
Total 4!�35.00
Invoice Total 4435.00j