American Structurepoint/Eng/24,960/Adl Serv #6/96th Street and Keystone Parkway Plan Review American Structurepoint,Inc.
Engineering Department-2016
Appropriation:ASA#6;#94-650.04;COIT Bond;P.O.#33933
Contract Not To Exceed$24,960.00
ADDITIONAL SERVICES AMENDMENT TO JA9;:
AGREEMENT FOR PROFESSIONAL SERVICES
THIS AMENDMENT TO THE AGREEMENT FOR PROFESSIONAL SERVICES ("Agreement") entered into
by and between the City of Carmel and American Structurepoint, Inc. (the "Professional"), as City Contract dated
April 6, 2016 shall amend the terms of the Agreement by adding the additional services to be provided by
Professional 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 et seq., which is attached hereto and incorporated herein as Exhibit "B", 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,
Professional shall certify,that in signing this document, it doesnot 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 American.Structurepoint, Inc.
by and through its Board of Public
Works and Safety
By: By:
/ ---z_./
mes Brainard, Presidin ffi Authorized Signature
D : 6 -
Z4fA E. 4 cWJ
Printed Name
Mary nn B ke, embef /% n
Date: // /tom V.ze --i�c�cs;le
NO+ Pe€ n + / Title
Lori S.Watson, Member FID/TIN: 35-- //273/7
Date:
Last Four,of SSN if Sole Proprietor
EST•"
�--..
Date: /41 l-r- Z/6
Christine r
(I).
te I/ISACoatr rsTrofS,,,,&Good,SI zlengblacingg''2I116VAmclican Sirudizermm.6r_ASA 1i&Add'I Svcs Auocn!3-27-2012 ait6 C-Vcrif)Lmguogu!oc:5/I7/2016 I:15 PSII
•
March 23, 2016
Mr. Jeremy Kashman
Cannel City Engineer
One Civic Square
Carmel, IN 46032
Re: 966 Street and Keystone Parkway Plan Review
Dear Mr. Kashman,
On behalf of American Structurepoint, Inc., I am pleased to submit this proposal for plan review
services.
The professional services will include plan review services for the intersection of 96th Street and
Keystone Parkway.
Upon receiving notice to proceed from the City of Carmel, American Structurepoint will
commence with the above professional services for plan review for a total lump-sum fee of
$24,960. Invoices will be forwarded to the City of Carmel on a monthly basis in accordance with
our contract.
We look forward to working with the City of Cannel on this project. If you should have any
questions,please do not hesitate to contact me at(317)547-5580.
Very truly yours,
American Structurepoint, Inc.
Michael Maurovich
Project Manager
MJM:mek
Attachment
cc: Mike McBride
201502101 I
Exhibit A
City of Carmel Program Management Scope Items
Plan Review Services
A. Engineer shall provide plan review comments for the following project:
1. 96th Street and Keystone Parkway
B. Plan review shall consist of one (1)submittal to American Structurepoint by the design firm.
C. Plan comments will be provided based on plan submittal.
D. American Structurepoint will review the engineer's responses to comments and offer feedback
and advice to the City of Carmel for proposed resolutions.
..,a<! •4E3a
T
Ofe___
March 23,2016 201502101
American Structurepoint,Inc.
Engineering Department-2016
Appropriation:ASA#6;#94-650.04;2016 COIT Bond;P.O.#3393 •
Contract Not To Exceed$24,960.00
EXHIBIT"B"
E-verify requirement
All terms defined in I.C. §22-5-1.7 et seq.are adopted and incorporated into this section of the Amendment.
Pursuant to I.C. § 22-5-1.7 et seq.,Vendor shall enroll in and verify the work eligibility status of all of its newly-hired
employees using the E-Verify program, if it has not already done so as of the date of this Addendum. Vendor is further
required to execute the attached Affidavit,herein referred to as "Exhibit C",which is an Affidavit affirming that: (i)Vendor is
enrolled and is participating in the E-verify program,and(ii)Vendor does not knowingly employ any unauthorized aliens.This
Addendum incorporates by reference, and in its entirety, attached "Exhibit C." In support of the Affidavit, Vendor shall
provide the City with documentation that it has enrolled and is participating in the E-Verify program.This Agreement
shall not take effect until said Affidavit is signed by Vendor and delivered to the City's authorized representative.
Should Vendor subcontract for the performance of any work under this Addendum, the Vendor shall require any
,subcontractor(s)to certify by affidavit that: (i)the subcontractor does not knowingly employ or contract with any unauthorized
aliens,and(ii)the subcontractor has enrolled and is participating in the E-verify program.Vendor shall maintain a copy of such
certification for the duration of the term of any subcontract. Vendor shall also deliver a copy of the certification to the City
within seven(7)days of the effective date of the subcontract.
If Vendor, or any subcontractor of Vendor, knowingly employs or contracts with any unauthorized aliens, or retains
an employee or contract with a person that the Vendor or subcontractor subsequently learns is an unauthorized alien, Vendor
shall terminate the employment of or contract with the unauthorized alien within thirty (30) days ("Cure Period"). Should the
Vendor or any subcontractor of Vendor fail to cure within the Cure Period, the City has the right to terminate this Agreement
without consequence. .
The E-Verify requirements of this Agreement will not apply, should the E-Verify program cease to exist.
[5:\Contracts\ProfSva&Goods Svcs\Enghteering\2016\Amcicnn Shucturcpoint,Inc.ASA#6 Add'1 Sva Amend 3-27-2012 with E-Verity langeege.doc:5/162016 2:14 PM]
American Structurepoint,Inc.
Engineering Department-2016.
Appropriation:ASA#6;#94=650.04;2016 COIT Bond;P.O.#3393
Contract Not To Exceed$24,960.00°
Exhibit"C"
E-Verify Affidavit
tier. 6rau vl ,being first,duly sworn,deposes and says that
he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this
'Matter, could testify as follows:
1. I am over eighteen (18) years, of age and am competent to.testify to the facts contained
herein.
_2. I am now and at all times relevant herein have been employed by
AMerr'cn0, raripre pviHi,"hoc. (the "Company") in the position
of Vice- frn s,,-r
3. I am familiar with the employment policies,practices, and procedures of the Company and
have the authority to act on behalf of the.Company.
4. The Employer is enrolled and participates in the federal E-Verify program and has
provided documentation of such enrollment and participation to the City of Cannel,
Indiana.
5. The,Company does not knowingly employ any unauthorized,aliens.
FURTHER AFFIANT SAYETH NOT:
/
EXECUTED on the l,cfc day.of //A Al ;20
4.-32 A
Printed: pa--'se-
certify under the penalties for per jury under the laws of the.United-States of America and the State of
Indiana that the foregoing factual statements and representations,are true and correct.
/2/04714v7—
OTZ, ®ifr ''� Printed: Ma�-�} -ef �'- 4..
.,6... ......... r3 /
NOTARY ..Wi
&* SEAL ,I c7
%,,i 11ae a
3 tj;'yE 4Pires SeQ.o'10.
0 \
\\' .\.tea
rrr�r>lard�O ,OF 1��\�"\\\\
ike
&-Gn, Sac.0f;neutec:iuc\?0161Mtuicnn Stnoancpoin,,itrc,.ASA116 hddl Six.Amend i.7-2012 with E-Y>i(y Ianpa;e.do S/16420162:14 Mij
wy 4 �T IFF��
aTTOIWIAZ
It-VERI/T TE slow,.or DM
Company ID Number.254011
To be accepted as a participant in E-Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E-Verify at 888-464-4218.
Employer American Structurepolnt,Inc.
Chelsea Shumaker
Name(Please ._. .--.. ..,. ... ,.......
Type or Print}. - 7Ftle _._ ,::.
Electronically Signed 09/1712009
Signature.: Date
Department of Homeland Security—Verification Division
USCIS Verification Division
Name(Please Type or Print) Title
Electronically Signed 09/17/2009
Signature plate.
•
Page 11 of 131E Verify MOU for EmployerlRevision Date 10129108 IMARAI.dh.3. 0,11E-Verify
uG
\\441y,
F-Ve1Fy - - n-Vann to A ftnVI.or uiu
Company ID Number.254011
information Required for the E ferify Program
Information relating to your Company:
Company Name:Americav Structurepoint,Inc.
Company Facility Address:7260 Shadeland Station
Indianapolis,IN 46256
Company Alternate
Address:
County or Parish: MARiOh!
Employer Identification
Number: 351127317 .
North American Industry .
Classification Systems
Code: 541
Parent Company:
Number of Employees: 100 to 499
Number of Sites Verified
for: 2
Are you verifying for more than 1 site?if yes,please provide the number of sites verified for In
each State:
OHIO 1 site(s)
Page 12 of 131E-Verify MOU for EmployerjRevisio i Date 10/29/08 www.dl'3s.govltE-Verify
y _
..L`.- � R-VSR1T1 13 A S3RUICA Or DNS•
1116
Company ID Number.254011
® INDIANA . :. 1 site(s)
r .
information relating to the Program Administrators)for your Company on policy questions or
operational problems:
Name, Chelsea Shumaker_
Telephone Number: (317)647-6680 Fax Number. (317)643-0270
E-mail Address cshumakergstructurepoint.com
Page 13 of 13IE-Verify MOU(or EmployerlRevisian Date 10/29/08 rovinv.citis.gov/E-Verify
i ,
N.M di'B a ®gyp 8:Mal,'
ats
F`- A CITY O 'MEL
May 16, 2016 JAMES BRAINARD, MAYOR
Mr.Willis R. Conner, PE, SE
Mr. Gregory L.Henneke,PE
Mr. Cash E. Canfield,PE
American Structurepoint, Inc.
7260 Shadeland Station
Indianapolis,IN 46256-3957
RE: Additional Service Amendment#5,P.O.#33931
Additional Service Amendment#6,P.O.#33933
Additional Service Amendment#7,P.O.#33750
Dear Mssrs. Conner and Henneke:
As we discussed, the City of Carmel has a need for additional professional services and pursuant to our current
contract with American Structurepoint, dated April 6,2016.I have requested and received from you the proposed
scope of services and fee estimates for the following work tasks:
Additional Service Amendment#5— 16-ENG-70—Rangeline Road from 116th Street to 4th Street SE
Engineering Services
Not to Exceed: $207,750.00
6Additional_Service Amendment#6 96th Street and Keystone Parkway Plan Review
Not to Exceed: $24,960.00
Additional Service Amendment#7— Corridor Survey Services—96th Street, Gray Road,Rangeline
Road
Not to Exceed: $226,531.00
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,
Jere M. ashman,P.E.
Ci Engineer
Reviewed and approved by:
,
DEPARTMENT OF ENGINEERING S. C Engelkmg
ONE CIVIC SQUARE, CARMEL, IN 46032 OFFICE 317.571.2441 FAx 317.571D3al ,tor of Administration
EMAIL engineering@carmel.in.gov
1 INDIANA RETAIL TAX EXEMPT Page 1 of 1
C iiCity of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 33933
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
CARMEL, INDIANA 46032 2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
5/15/2016 00350562 Contract Date 04.06.16
AMERICAN STRUCTURE POINT, INC City Engineering's Office
VENDOR 7260 SHADELAND STATION SHIP 1 Civic Square
TO Carmel, IN 46032-
INDIANAPOLIS, IN 46256--3957 Kate Lustig
PURCHASE ID I BLANKET I CONTRACT I PAYMENT TERMS I FREIGHT
4841
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 2200 Account: 94-650.04 Fund: 0 COIT Bond Fund
1 Each ASA 6-96th Street and Keystone Plan Review $24,960.00 $24,960.00
Sub Total $24,960.00
,,,.r `tea"",•
f y 0Y
K}}
t
y
. N.
X +ti-.R. S,i
1 / '
-,
4
Send Invoice To: �4 s, ' �_ ;' 1.
r x
Skip Tennancour .,, ,/
8425 Wicklow Way N. n; ,,,,,,,r, -.. .
Brownsburg, IN 46112 41'i lA41.- i^' k-'j """
ff ._..: .
2016 COIT Bond
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ' ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
PAYMENT $24,960.00
SHIPPING INSTRUCTIONS •A/P 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
'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
TITLE
CONTROL NO. 33933 CLERK-TREASURER