Central Indiana Hardware/FIRE/21,826.42/ADDl Serv 1/Installation of doors Central Indiana Hardware
Carmel Fire Department-2013
Appropriation 443-501.00; P.O. 424457
Contract Not To Exceed$21,826.42
ADDITIONAL SERVICES AMENDMENT TO cRO�
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ette%
o
THIS AMENDMENT TO THE GOODS AND SERVICES AGREEMENT ("Agreement') entered into by and
between. the City of Carmel and Central Indiana Hardware (the "Vendor"), as City Contract number 02.04.09.05,
dated February 4,2009 shall amend the terms 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°AD. 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,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 Central Indiana Hardware
by and through its Board of Public
Works and Safety B .t��q �
y' , By: / G/i'1�.na&4
s Brainard, Presiding Of4r Authorized Signature
F1/7 (J T / Printed Name
Mary Date: Burke,Member
7 -/ Sig tar Meop -444CA
Title
Lori S.Wat t ember FID/TIN: $``—2,3307/7/8 Date: S(rr /13
Last Four of SSN if Sole Proprietor. NM
ATTEST: 7// 20/3
"' !/ , Date: /
D' na Cordray, IA r' ' rk-Treasurer
Date: 7// 7)
IM,r.n#-rke—..8..ta a,,..RdSs fmi.S• Nn tlq.WU■lmtl ids I4_ ASA.datrfir713.X.MI
CITY OF ckit.
Fire Department Headquarters
2 CIVIC SQUARE
CARMEL, INDIANA 46032
317-571-2600
June 3, 2013
Mr. Greg Dunnavant
Central Indiana Hardware
P.O. Box 2025
Indianapolis, IN 46206
RE: Additional Services Amendment#1, (P0 #24457)
Dear Mr. Dunnavant:
As we discussed, the City of Carmel has a need for additional professional services and pursuant to our
current contract with Central Indiana Hardware, dated 02.04.09.05.1 have requested and received from you
the proposed scope of services and fee estimates for the following work task:
Additional Service: Installation of Doors at Fire Station #41
Building Repairs
Not to Exceed: S21,826.42
Per our contract procedural requirements, I hereby approve this "Additional Professional Services" estimate,
and request that the Board of Public Works ratify the above reference Contract Amendment.
PLEASE NOTE:
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 Services # and include the P.O.# shown above. Invoices submitted without this information
will be returned to your office. 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
Res.ectfully,
�
Matthew F. Hoffmai
Fire Chief
City of Carmel
Exhibit k
•
Central Indiana Hardware
Cannel Fire Department-2013
Appropriation#43-501.00; P.O.#24457
Contract Not To Exceed$21,826.42
Exhibit"C"
E-Verify Affidavit
, being fust duly sworn,deposes and says that
he/she is 1. uiliar with and has personal knowledge of the facts herein and, if called as a witness in this
matter,could testify as follows:
1. 1 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
et-Linz 4c- Jlu a t,l,. j'JCrn .&f, e- (the "Company") in the position
of c IGGS IYIAIVA i . .
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 G day of L., v �- ,20!3t
Printed: 46 54. -01/./It/AvPivr
I certify under the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements and repres tations are e and correct.
‘, ,
-• Printed: 4tw4 PJ(4/nVhM
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