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Crossroad Engineer/ENG/Addl Ser 8/5,378.30/path keystone to gray - Crossroad Engineers Engineering-20/4 Appropriation#211-40/: P.O. #31903 Contract Not To Exceed$5.378.30 ADDITIONAL SERVICES AMENDMENT TO AGREEMENT FOR PURCHASE OF GOODS AND SERVICES uct+ THIS AMENDMENT TO THE GOODS AND SERVICES AGREEMENT ("Agreement") entered into by and between the City of Carmel and Crossroad Engineering (the "Vendor'), as City Contract dated May 1, 2013 shall amend the tenns of the Agreement by adding the additional services to be provided by Vendor consistent with the Scope of Work attached hereto and incorporated herein as Exhibit "A". Furthermore, the terms of the Agreement shall be amended to include the E-verify requirement as stated in Indiana Code § 22-5-1.7 at seq., which is attached hereto and incorporated herein as Exhibit "8", as well as the required E-verify Affidavit, attached hereto and incorporated herein as Exhibit "C". Also, pursuant to I.C. § 5-22-16.5, Vendor shall certify that in signing this document, it does not engage in investment activities within the Country of Iran. The terms and conditions of the Agreement shall not otherwise be affected by this Additional Services Amendment and shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment as follows: CITY OF CARMEL, INDIANA Crossroad Engineers by and through its Board of Public Works and Safety �. By: r----70 dries Brainard, Presiding Officer Authori ed Signature Date: (�2GL� C. 1V el� r Printed Name Mary An Burke, Membe , I Date: 3 - � �� V rte — 'Jf Title Lori S. Wasson' 3 b-r,/� Title N: � — Date: Last Four of SSN if Sole Proprietor: �ST , .41111� Date: 3/1'(' /14 .nano Cordray, IAM7 lerk-Treasurer Dale: �IU U o O o 11irib -.8 ® u 0 1 0 QC:18;. wpm February 25, 2014 CITY 0 - -AR IEL Mr. Chip Charles, P.E. TAMES BRAINARRD, MAYOR Mr.Trent Newport, P.E. CrossRoad Engineers, P.C. 3417 South Sherman Drive Beech Grove, IN 46107 RE: Additional Service Amendment#8, P.O. #31903 Dear Chip and Trent: As we discussed, the City of Carmel has a need for additional professional services and pursuant to our current contract with CrossRoad Engineers, Contract dated November 20 2013, 1 have requested and received from you the proposed scope of services and fee estimates for the following work task: Additional Service Amendment#8— 13-08; Main St. Path from Keystone to Gray Design Supplement Not to Exceed: $5,378.30 Per our contract procedural requirements, I hereby approve these Additional Professional Services estimates, and request that the Board of Public Works ratify the above referenced Contract Amendment. PLEASE NOTE Please be advised that "Additional Services" performed on City contracts must be billed separately from the original contract and other additional services. More importantly, the invoice must reference the appropriate Additional Service# and P.O.# shown above. Invoices received without the Additional Service# referenced will be returned for proper identification. Thank you for your continued assistance in providing the City of Carmel with your professional, quality services. If you should have any questions, please give me a call. Sincerely, 2 7, Michael T. McBride,P.E. City Engineer Exhibit I 16 Reviewed and approved by: l S. C. E elking DEPARTMENT or ENGINEERING Director of Administration ONE Civic Socear:. CARMEL. IN 46032 OEra- 317571.2441 PAN 317.571.2139 EMAIL tng[ncaing!cunncl.fn.guv CityINDIANA RETAIL TAX EXEMPT PAGE 1\ . 11 ty ©f C a rme II CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER \4U1V//a ��/L�!t �Y 11 FEDERAL EXCISE TAX EXEMPT �, 0 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIP SHIPPING LABELS AND ANY CORRESPONDENC rORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 RCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. _ DESCRIPTION CYG5S/0 1 Fr O J r5 SHIP >e��. O� CY�Q\ V1CS �� VENDOR �\ TO `J I YI .ONFIRMATION I BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION ASji TI 2 t c -,5E- `' iel'o ocC iY .fie_ S \ 11 t 0 �3� �L �4 - j tv` \ c�- �- ; 1Ce_ cYw \o C-Tra a r Send Invoice To: ��` r C� A c I'' 9- --1' So 2v1-9 01 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT PAYMENT • PIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN •SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. •,C OD.SHIPMENTS CANNOT BE ACCEPTED. • PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY ISHIPPING LABELS. Ir THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE t AND ACTS AMENDATORYTHEREOF AND SUPPLEMENT THERETO. -'� CLERK-TREASURER I DOCU N MENT_CONTROL O. 31903 , VENDOR COPY