Clark Dietz, Inc/Eng/97,847/Adl Serv #3/Small Structure Replacement Under Jumper Lane South of 106th StreetClark Dietz, Inc.
Enbineering Department.- 2GI6
Appropriation AsA #3, #94: 650.04, 2016,Storm Water Bond;; P.O.. #33994:
Contract Not To. Exceed $97,347.00 ue p
ADDITIONAL SERVICES AMENDMENT TO
AGREEMENT FOR PROFESSIONAL SERVICES
THIS -AMENDMENT TO THE PROFESSIONAL -SERVICESAGREEMENT ("Agreement") entered irito-by and
between the City of Carmel and Clark Dietz; Inc. (the: `Professional"). as City Contract. dated Maya 4, 201'6 shall;
amend the terms of -the Agreement by adding the additional services to be provided 'by Professional ;consistent; with
the Scope of Work::attachedhereto and incorporated herein as Exhibit_'W', Furthermorei the terms of'the Agreement
shall be amended: to- include -;the °E -verify requirement as stated in Indiaria Code § 22 - et seq.,.whch 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 notengage 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 executedthis-Amendment as follows:
CITY OF CARMEL, INDIANA
by and through its, Boardof Public
Works and -Safety
By:
-No+
James Brainard; Presiding Officer
Date:
Mary An
Date: _
Lori S.
Date:
Clark.Dietz; Inc.
By:
Authorized Signature /
�Gihs J. /",ei�rsch .
Printed Name
Se-- VJGe fires ��enT'
Title
FID/TIN: 37-1,21,205J
Last Four of SSN if Sole Proprietor:
A ST.
� Date: �� O �' oZ0/�
pristine Pa le ,fie -Treasurer
Date:
IS:'Ux Zn 0Fn,rS+ & C-1, Di"... 1— ASA 03 A,ut SI.. MIC.,1307-_2012 with E2-Yaily I:mnugcA,w:G?r:01G I1:2i Aaq
rk Di
June 6, 2016
PROJECT DESCRIPTION: Small Structure Replacement under Jumper Lane 0.15 miles south of 106`h
St. in City of Carmel, Hamilton County, Indiana
SCOPE:
The scope for this project is the design of a small structure replacement project in the City of Carmel. The
project is located on an un -named tributary (UNT) of Williams Creek, located west of Williams Creek on
Jumper Lane, 0.15 miles south of 106th St. The anticipated project schedule includes a preliminary field check
in Fall 2016 with design being completed Summer 2017. Construction is anticipated for Fall 2017.
Our scope will include the following services for the project:
1. Design — Small Structure Replacement and Scour Protection
2. Contract Documents and Bidding Assistance
3. Utility Coordination
4. Permit Applications (ACOE 404, IDEM 401)
5. R/W Engineering (Legal Description and Parcel Plat)
6. Meetings & Coordination with Laurelwood HOA
7. Geotechnical Investigation
8. Topographical Survey
9. Waters of the U.S. Report / Wetland Delineation
EX 3 I"' . A
1
® Clark Dietz, Inc. 8900 Keystone Crossing, Suite 900 Indianapolis, Indiana 46240 T: 317.844.8900 F: 317.844.9158
Fee Summary
UNT Williams Creek Structure Replacement
106th St. & Jumper Lane
City of Carmel
FEE SUMMARY
kit
2017 construction
Jumper Lane Culvert
Total = $97,847
Assumptions
1) Local Project - CE Documentation not required
M 2) Wetland Mitigation not anticipated
3) Archeaological Field Recon. not anticipated
4) Section 4(f) not anticipated
5) IDEM Rule 5 Permit not anticipated
CIO 6) DNR Construction in Floodway Permit not required (drainage area <1 sq. mi)
7) City Standards to be utilized for pavement section
8) Anticipated 3 parcels for land acquisition.
9) Jumper Lane anticipated for construction in 2017.
10) hourly item for utility coordination (hourly rates: $130 for PM / Project Engineer and $115 for senior technician).
11) hourly item for meetings / coordination with HOA included for 106th St. culvert (hourly rates: $167 for Roadway Group Lead and $130 for PM / Project
Engineer).
P.\C0330110_Camd -106th Culvert\ProjMgt\FeeData\106th St Culvert Design\106th St Culvet Design MH -Fee Justification.xlsc
6/6/2016
1of7
Task Description
Fee
y
d
S
Desi Small Structure Replacement) (LSUM)
$35,900
Contract Documents & Bidding Assistance (LSUM)
$8,200
V
Utility Coordination OT TO EXCEED)
$8,900
A
Permit Applications (COE 404, IDEM 401) (LSUM)
$8,800
x
R/W Engineering - Legal Description & Parcel Plat ($3,233 /parcel)
$9,700
w
U
Hourly for meetings & coordination with Laurelwood HOA (NOT TO EXCEED)
$5,000
a
Geotechnical Investigation (Earth Exploration) (UNIT PRICES)
$4,330
Title Search (USI) (based on 3 parcels per project site, $450 /parcel)
$1,350
a S
Field Survey (USI) (LSUM)
$12,009
aR/W
Staking - not included per City request
n/a
Waters of the US Report / Wetland Delineation Green3) (LSUM)
$3,658
Right -of -Way Acquisition (City of Carmel to oomplde
Total = $97,847
Assumptions
1) Local Project - CE Documentation not required
M 2) Wetland Mitigation not anticipated
3) Archeaological Field Recon. not anticipated
4) Section 4(f) not anticipated
5) IDEM Rule 5 Permit not anticipated
CIO 6) DNR Construction in Floodway Permit not required (drainage area <1 sq. mi)
7) City Standards to be utilized for pavement section
8) Anticipated 3 parcels for land acquisition.
9) Jumper Lane anticipated for construction in 2017.
10) hourly item for utility coordination (hourly rates: $130 for PM / Project Engineer and $115 for senior technician).
11) hourly item for meetings / coordination with HOA included for 106th St. culvert (hourly rates: $167 for Roadway Group Lead and $130 for PM / Project
Engineer).
P.\C0330110_Camd -106th Culvert\ProjMgt\FeeData\106th St Culvert Design\106th St Culvet Design MH -Fee Justification.xlsc
6/6/2016
1of7
Clark Dietz, Inc.
Engineering Department - 2016
Appropriation: ASA #3, #94-650.04, 2016 Storm Water Bond; P.O. #33994
Contract Not To Exceed $97,847.00
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:\Coo1rac1s\Prof.Svcs & Goads Svcs\Enginecring\2016\C1ark Dim Ina ASA #3 Add? Svcs Am nd 3-27-2012 xilh E -Verify Iangaege.dac:6A2016 11:25 AM[
Clark Dietz, Inc.
Engineering Department - 2016.
Appropriation: ASA. #3; #94-650:04, 2016 Storm Water Bond; P.O. #33994
Contract Not To Exceed $97;$47:00
Exhibit "C'
E -Verify Affidavit
Ath s �]_. ! e f�rsa r�, , beingfirst duly sworn, deposes and -says drat
he/she is familiar with=and has persorial_knowledge of the facts laeieinand, if called..as a witness. ihthis
matter, could testify as follows:
1. I am over eighteen (18) years of age and am competent toz testify to the factscontained
Herein.
2. f am, now, and 1t all times relevant herein. have been employed b-
G , r 1,14C . the "Company") in the ppsrtioi
of 15'r. VrCP / r� Si o�G ti
3. I aril familiar with the employment policies, practices; -Ind procedures: of:thee 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 documeritatiori of such enrollment and participation. to the ity Cof Carmel,
iridiana..
5: The Company :does not knowingly ernplgy any unauthorized aliens:
FURTHE-R AI'FIANT SAYETH NOT.
'EXECU.TED 'oil the V. clay :of 7t4in e.
Printed : AAl s�% . f t' f t meso *n
I certify under- the penalties for perjury under the laws of the United States of America and the State of
Indiana that the loregoirig factual statements and representations are true and correct.
Printed: 9ahS V / e/C/ 510h
IS:lemuom-o,rnuScc>& r,-!, Dieu_ hie. ASA P: A&I7 S, Aino,d 3-27-012-11, U -V nfy {: 1125 ANC,
Company ID Number. 436844
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 Clark Dietz, Inc
;Jon Howvaniec
'Name (Please Type or Printf ( Title
ElectronicallySlgned._ j ,0810212011
:Signature Date
i
Department of Homeland Security— Verification Division
''SCIS Verification DiAsIon _
'Name (Please Type or Print) ` Tllie
;Electronically S[gned S 08!0212011
:Signature Dale
r
InformatiOn Required for the E -Verify Program
.Information relating to,your Company_ _
l
i Company Name,',Clark Dietz, Inc
i •
Company Facility Address "118 S. Clinton St.
'Suite 700
} .. ... Chicago, IL 60618
Company Alternate
Address:
i
Coullty or Parish:. ?COOK i
i
Employer identification
Number: .:3712`12061
Page 12 of 131E Verify MQU for Employer I Revision Dale 09/01/00 www.dhs.gov/E-Verify
Company ID Number: 436844
North American Industry
Classification Systems i
Code: d41
Administrator;
Number of Employees, .100 to 499
Number of Sites Verified
for:
-Are you verifying for more than t site? If yes, please provide the number of sates verliled for
ju each State:
o WISCONSIN 3 sites)
0 ILLINOIS 2 sites)
INDIANA 2 siic(s)
Information relating to the Program Administrator(s) for your Company on policy
questions or operational problems:
Name; Jon B1101yanice
Telephone Number: (312) 648 .9900 ext. 259 Fax Number:
E-mail Address: jon.bowanicc a@clark diemcurn
Name: Joanna Cabal
Telephone Number: (312) 648 -9900 Pax Number;
E-mail Address: joanna.cabalQclaelr-dietz.com
Page 13 of 131 E -Verify MOU for Employer I Revision Data 09/01/09 VVWW.dhs.gov1E Verify
Received
06-07-16A09:00 RCVD
City of Carmel
Department of Law
LETTER OF TRANSMITTAL
Date: June 6, 2016
To: Doug Haney
Department of Law
From: Jeremy Kashman64'�
Department of Engineering
RE: Clark Dietz, Inc. Additional Service Amendment
One additional service amendment is needed for Clark Dietz for the June 15th BPW meeting, please.
Attached please find the work proposal and purchase order.
Contract Information:
Project Name: ASA 3 Small Structure Replacement under
Street - Design
Vendor:
Clark Dietz, Inc.
Amount:
$97,847.00
Appropriation:
PO 33994; 2016 Storm Water Bond
Signature:
James Loew, P.E.
Address:
8900 Keystone Crossing, Suite 900
Indianapolis, IN 46240
Phone:
317/808-9158
Email:
iim.loew(a�clarkdietz.com
Jumper Lane 0.15 Miles South of 106th
June 6, 2016
Mr. James Loew, P.E.
Clark Dietz, Inc.
8900 Keystone Crossing, Suite 900
Indianapolis, IN 46240
,JAMES BRAINARD, MAYOR
RE: Additional Service Amendment #3, PO #33994
Dear Mr. Loew:
As we discussed, the City of Carmel has a need for additional professional services and pursuant to our current
contract with Clark Dietz, Inc., dated May 4, 2016, I have requested and received from you the proposed scope of
services and fee estimates for the following work task:
Additional Service Amendment #3— Small Structure Replacement under Jumper Lane 0.15 Miles
South of 106th Street
Not to Exceed: $97,847.00
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,
Jef y Kshman, P.E.
City Engineer
R ie ed and approved by:
1. C. Enge ' g
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
/f (�
(( ityo Carmel
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
Page 1 of 1
PURCHASE ORDER NUMBER
\ / JL
FEDERAL EXCISE TAX EXEMPT
33994
ONE CIVIC SQUARE
35-6000972
THIS NUMBER MUST APPEAR ON INVOICES, AJP
CARMEL, INDIANA 46032-2584
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR
CITY OF CARMEL - 1997
SHIPPING LABELS AND ANY CORRESPONDENCE
(PURCHASE ORDER DATE
DATE REQUIRED
I REQUISITION NO.
VENDOR NO.
DESCRIPTION
6/6/2016
060650
Project 16 -SW -79; Contract Date 05.04.16
CLARK DIETZ, INC
City Engineering's Office
VENDOR 8900 KEYSTONE CROSSING #900
SHIP 1 Civic Square
TO Carmel, IN 46032 -
INDIANAPOLIS, IN 46240 -
Kate Lustig
PURCHASE ID BLANKET CONTRACT
PAYMENT TERMS
FREIGHT
5379
QUANTITY UNIT OF MEASURE
DESCRIPTION
UNIT PRICE I EXTENSION
Department: 2200 Account: 94-650.04 Fund: 0 2016 Storm Water Bond
1 Each ASA 3 - Small Structure Replacement under Jumper Lane $97,847.00 $97,847.00
0.15 Miles South of 106th Street
Sub Total $97,847.00
Send Invoice To:
Jill Newport
CrossRoad Engineers, P.C.
3417 Sherman Drive
Beech Grove, IN 46107
G.O./Storm Water Bonds
-- PLEASE INVOICE IN DUPLICATE
DEPARTMENT IACCOUNT
SHIPPING INSTRUCTIONS
'SHIP PREPAID.
'C.O.D. SHIPMENT CANNOT BE ACCEPTED.
'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. 33994 CLERK -TREASURER
PROJECT i PROJECT ACCOUNT AMOUNT
PAYMENT $97,847.00
AIP 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. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.