American Structurepoint, Inc/Eng/6,630/Adl Serv #12/West Main Street Streetscape Improvements American'Structurepoint,Inc. •
Engineering Department-2016 •
Appropriation:ASA#1'2;#94-650.08;201.0 COIT Boni;P.O.#33940
Contract Not To.Exceed$6,630.00 ' Zt:O
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A DITIONAL SERVICES AMENDMENT TO
AGREEMENT FOR PROFESSIONAL SERVICES
THIS AMENDMENT TO THE AGREEMENT FOR PROFESSIONAL SERVICES ("Agreement') entered into
by and between the City of Carmel and American Structurep.oint, Inc. (the "Professional"), as City Contract dated
March 20, 2013 shall amend the terms of .the Agreement by adding the additional services to be provided by
Professional consistent with the Scope of Work attached hereto and incorporated herein as Exhibit "A".
Furthermore, the terms of the Agreement shall be amended to include:the E-verify requirement as stated in Indiana
Code § 22-5-1.7 et seq., which is attached hereto and incorporated herein as Exhibit 'B", as well as the required E-
verify Affidavit, attached hereto and incorporated herein as Exhibit "C". Also, pursuant to I.C. § 5-22-16.5,
Professional shall certify that in signing this document, it does not engage in investment activities within.the Country
of Iran. The terms and conditions of the Agreement shall not otherwise be affected by this Additional Services
Amendment and shall remain in full force and effect.
•
IN WITNESS WHEREOF, the parties hereto have made.and executed this Amendment as follows:.
CITY OF CARMEL, INDIANA American Structurepoint, Inc.
by and through its Board of Public
Works and Safety
By: By: 6D\2L_\_-
James Brainard, Presiding Officer Authorized Signature.
te:
611.'/4.5 de. (;tuner
Printed Name
Mary Ann B rke, mb r
Date: ���� f resagyr
Title
Lori-S.Watson, ember FID/TIN: 3s"- l/27- 3/7
Date: 'i
r` Last Four of SSN if Sole Proprietor:
(A( E
Date: 5une 3, 20/6
( rist1ne Pauley, easurer
Date: (��
t$'Qm„mc,p,„r.Sv s.0 Cso:ilL Svestaviuccrin,0110Amcriimu$tru:',orq.ut.Inc.ASA P12 Add?Svcs ATend 3.27-20t2 w 1h L'.V rift'Iraigwgc.oloc:N1fb169:13 AM
American Structurepoint,Inc.
Engineering Department-2016
Appropriation:ASA#12;#94-650.08;2010 COIT Bond;P.O.#33940
Contract Not To Exceed$6,630.00
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.•
[S:\Contracts\Prof.Svcs&Goods Svos\Engineering\2016\American Struclmepoint,Inc ASA#12 Add7 Svcs Amend 3-27-2012 with E-Vcri(y languago.doc.6/12016 9:13 AM]'
American Structurepoint,Inc.
Engineering Department-2016
Appropriation:ASA#12;#94-650.08;2010. COLT Bond;P.O.#33940
Contract Not To Exceed.$6,630.00
Exhibit"C"
E-Verify Affidavit
Ben 13ra.14.YI , 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.
S-tr.- /.00,•p,4 /H c. (the "Company") in the position
of Vice_ P>es,•G1e„f
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 Carmel,.
Indiana.
5. The Company does.not knowingly employ any unauthorized aliens.
FURTHER AFFIANT SAYETH NOT.
EXECUTED on the 3 day of ,t�+E ,20
A J
Printed: /SE.... . /54A0-✓'
I certify tinder the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements arid representations are true and correct.
1,01TZ,NO�41, /
c* .•4S ems;4.,A .1 Printed: /v1aej ee+ C. ?.cyFZ
• i ce , NOTARY Val
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(s:`.Cfm:m,Trn(S.rs CG:xrk srczinitincering_Ol&/gncri:,n slrutuca7c0.Inc.1SA 412 t coma 3?7::01:<r;,h E.V ilsInngu.7gcAnc..r,It2OI69:I ANli
LETTER OF TRANSMITTAL
Date: May 25, 2016
To: Doug Haney
Department of Law
From: Jeremy Kashman
Department of Engineering
RE: American Structurepoint, Inc. Additional Service Amendment
One additional service amendment is needed for American Structurepoint for the June 15th BPW
meeting, please.
Attached please find the work proposal and purchase order.
Contract Information:
Project Name: ASA#12—West Main Street—Streetscape Improvements
Vendor: American Structurepoint, Inc.
Amount: $6,630.00 W4f ` " ' '
Appropriation: PO #33940; 2010 COIT Bond !„.`PpQ r
Signature: Willis R. Conner
Address: 7260 Shadeland Station
Indianapolis, IN 46256 if.0 (3?
Phone: 317/547-5580 -x4 d •
Fax: 317/543-0270 fta
Email: wconner@structurepoint.com
OFT
ya
6N.M.
at,,/ a KO 4% .3 e
eKy6-VIA111 IA A SERVIfC or DNS
Company ID Number 254011
information;Required for the E.Verify Program
Information relating to your Company:
Company Name:,American Structurepoint,Inc.
Company Facility Address:-7260 Shadeland Station
Indianapolis,ItI 46256
Company Alternate
Address:
4
County or Parish: F ARIORl
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 MOLL for EmployerlRevision Date 10/29/08 .dhs,gov1 -Verify
° y 6 van irr 23 A IZAVICL Of 1613
Company ID Number.254011
• INDIANA 1 site(s)
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)543-0270
E-mail Address: cshumakerlstructurepolnt.com
Page 13 of 131E-Verify MOD for EmployerlRevision Date 1029/08 www.dhs.gov/E-Verify
4
—.
tg) 1.
Company ID Number: 440231
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 CrossRoad Engineers,PC
Jill Newport
Name(Please Type or Print) y ITitte
;Electronically Signed I :08/15/2011
Signature € (ate
,Department of Homeland Security—Verification Division
`USC1S-Verification Division
:Name(Please Type or Print) Title
!Electronically Signed 1 08115/2011
signature [ ate
I i #
1 i
Information Required for the E-Verify Program
Information relating to your Company:
Fi
Company Name:CrossRoad Engineers,PC .......... .__.._...__..._._.
Company Facility_Address k3417 Sherman Drive
Beech Grove,IN 46107
€ I
Company Alternate
Address:
417 Sherman Drive
Beech Grove IN 46107
I €
County or Parish: MARION ........_...._._..._................._._...._._.........__._.
E � i
Employer Identification
Number: 351963331
Page 12 of 13 I E-Verify MOU for Employer i Revision Date 09/01/09 WWw.dhs.gov/E-Verify
'Ca
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CITY O 7 A EL
.JAMES BRAINARD, MAYOR
May 25,2016
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#12,P.O.#33940
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 March 20, 2013. I have requested and received from you the proposed
scope of services and fee estimates for the following work task:
Additional Service Amendment#12— 14-06—West Main Street—Streetscape Improvements
Engineering Services
Not to Exceed: $6,630.00
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 . ashman,P.E.
C. Engineer
Review d and approved by:
S. C�.. Engelking
Director of Administration
DEPARTMENT OF ENGINEERING
ONE CIVIC SQUARE, CARMEL, IN 46032 OFFICE 317.571.2441 FAx 317.571.2439
EMAIL engineering@carmel.in.gov
Page1of1
City INDIANA RETAIL TAX EXEMPTof cauriririiel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 33940
ONE CIVIC SQUARE • 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL,INDIANA 46032-2584 VOUCHER DELIVERY MEMO,PACKING SUPS,
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
5/26/2016 00350562 Project 14-06;Contract Date 03.20.13
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
5186
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 2200 Account: 94-650.08 Fund: 0 2010 Bond Fund
1 Each ASA 12-West Main Street Streetscape Improvements $6,630.00 $6,630.00
Sub Total $6,630.00
Z £gib ,,,'" iA
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Send Invoice To: N.i ‘;;�.� _v. ,_'_��. I
City Engineering's Office }�
tn. y.
Kate Lustig . ~" dam-- ;..
1 Civic Square ., „= a - '`
Carmel, IN 46032- .s az1 ^-`
��'" .., . ems.
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $6,630.00
SHIPPING INSTRUCTIONS *AlP 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 UNOBUGATED 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 / -P
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY ,
TITLE /r/���t
CONTROL NO. 33940 CLERK-TREASURER