Form No Dtmb 3521 PDF Details

Understanding the complexities of contract amendments within the State of Michigan's procurement ecosystem necessitates familiarity with specific forms and their implications, notably the No. DTMB-3521 form, updated in April 2012. This form plays a critical role under the authorization of Act 431 of 1984, mandating its completion for the successful execution of contract changes. Its significance is underscored by the stipulated penalty for non-compliance: without duly completed and filed DTMB-3521 forms, planned contract modifications are not implemented. The form facilitates various adjustments, including but not limited to the extension of contract terms, revisions of contract value, and amendments to delivery schedules or payment terms. For instance, detailed in the form's recent usage records are notable adjustments to contracts for Dynamic Message Signs facilitated between the State of Michigan and vendors such as Ledstar, Inc., highlighting extensions, value adjustments, and the enforcement of options for additional contract years. These examples serve to illustrate the form's utility in maintaining the flexibility necessary for adapting to changing project needs or extending fruitful contracts beyond their original scope, all while ensuring compliance with state procurement regulations and safeguarding the interests of both the state and its contractual partners.

QuestionAnswer
Form NameForm No Dtmb 3521
Form Length103 pages
Fillable?No
Fillable fields0
Avg. time to fill out25 min 45 sec
Other namesNEMA, NTCIP, addendum to west michigan regional purchase agreement, MDOT

Form Preview Example

Form No. DTMB-3521 (Rev. 4/2012)

AUTHORITY: Act 431 of 1984

COMPLETION: Required

PENALTY: Contract change will not be executed unless form is filed

STATE OF MICHIGAN

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

PROCUREMENTMay 19, 2014 P.O. BOX 30026, LANSING, MI 48909

OR

525 W. ALLEGAN, LANSING, MI 48933

CHANGE NOTICE NO. 4

to

CONTRACT NO. 071B9200263

between

THE STATE OF MICHIGAN

and

NAME & ADDRESS OF CONTRACTOR:

PRIMARY CONTACT

EMAIL

 

 

 

 

Ledstar, Inc.

 

 

 

 

 

 

 

 

 

Milan Patel

 

 

 

 

 

milan@ledstar.com

 

 

131 Westcreek Drive

 

 

 

 

 

 

 

 

 

TELEPHONE

 

 

 

 

CONTRACTOR #, MAIL CODE

 

 

 

Woodbridge, Ontario, L4L 9N6

 

 

 

 

(905) 265-7800 ext. 206

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE CONTACTS

 

 

 

AGENCY

 

 

 

NAME

 

PHONE

 

 

EMAIL

 

 

 

CONTRACT COMPLIANCE

 

 

 

MDOT

 

Michele Mueller

 

(248) 431-1443

 

 

 

mmuellerm2@michigan.gov

 

 

INSPECTOR

 

 

 

 

 

 

 

 

 

 

BUYER

 

 

 

DTMB

 

 

Sue Cieciwa

 

(517) 284-7007

 

 

 

cieciwas@michigan.gov

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTRACT SUMMARY:

 

 

 

 

 

 

 

 

DESCRIPTION: Dynamic Message Signs – Michigan Department of Transportation

 

 

 

 

 

INITIAL EFFECTIVE DATE

 

 

INITIAL EXPIRATION

 

 

INITIAL AVAILABLE

 

EXPIRATION DATE BEFORE CHANGE(S)

 

 

 

 

 

DATE

 

 

 

 

OPTIONS

 

 

 

 

 

 

NOTED BELOW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July 21, 2009

 

 

 

July 20, 2012

 

 

 

2, one year

 

 

 

 

 

July 20, 2014

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT TERMS

 

 

 

F.O.B

 

 

 

SHIPPED

 

 

SHIPPED FROM

 

 

 

Net 45 Days ARO

 

 

 

Delivered

 

 

 

90-120 Days ARO

 

 

 

 

 

Canada

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALTERNATE PAYMENT OPTIONS:

 

 

 

 

 

 

 

 

AVAILABLE TO MiDEAL PARTICIPANTS

 

 

 

P-card

Direct Voucher (DV)

 

 

 

Other

 

 

Yes

 

No

 

 

MINIMUM DELIVERY REQUIREMENTS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Unit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIPTION OF CHANGE NOTICE:

EXTEND CONTRACT

EXERCISE CONTRACT

EXTENSION BEYOND

LENGTH OF

EXPIRATION DATE

EXPIRATION DATE

OPTION YEAR(S)

CONTRACT OPTION YEARS

OPTION/EXTENSION

AFTER CHANGE

No

Yes

 

 

Six Months

January 20, 2015

VALUE/COST OF CHANGE NOTICE:

ESTIMATED REVISED AGGREGATE CONTRACT VALUE:

$360,000.00

$4,612,808.00

Effective June 10, 2014, this Contract is EXTENDED six months, therefore the Contract expiration date is hereby CHANGED to January 20, 2015. In addition, this Contract is hereby INCREASED by $360,000.00

All other terms, conditions, specifications, and pricing remain unchanged.

Per agency request dated May 2, 2014, DTMB, Procurement request dated May 13, 2014, vendor agreement by email dated May 13, 2014.

Form No. DTMB-3521 (Rev. 4/2012)

AUTHORITY: Act 431 of 1984

COMPLETION: Required

PENALTY: Contract change will not be executed unless form is filed

STATE OF MICHIGAN

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

PROCUREMENT

P.O. BOX 30026, LANSING, MI 48909

OR

530 W. ALLEGAN, LANSING, MI 48933

CHANGE NOTICE NO. 3

to

CONTRACT NO. 071B9200263

between

THE STATE OF MICHIGAN

and

NAME & ADDRESS OF CONTRACTOR:

PRIMARY CONTACT

EMAIL

 

 

 

 

 

Ledstar, Inc.

 

 

 

 

 

 

 

 

 

 

Milan Patel

 

 

 

 

 

 

milan@ledstar.com

 

 

 

131 Westcreek Drive

 

 

 

 

 

 

 

 

 

 

TELEPHONE

 

 

 

CONTRACTOR #, MAIL CODE

 

 

 

 

Woodbridge, Ontario, L4L 9N6

 

 

 

 

(905) 265-7800 ext. 206

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE CONTACTS

 

 

 

AGENCY

 

 

 

 

 

NAME

 

 

PHONE

 

 

 

EMAIL

 

 

 

 

CONTRACT COMPLIANCE

 

 

 

MDOT

 

 

Michele Mueller

 

248-431-1443

 

 

 

muellerm2@michigan.gov

 

 

 

INSPECTOR

 

 

 

 

 

 

 

 

 

 

 

BUYER

 

 

 

DTMB

 

 

Jim Wilson

 

517-241-1916

 

 

 

Wilsonj4@michigan.gov

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTRACT SUMMARY:

 

 

 

 

 

 

 

 

 

 

 

DESCRIPTION: Dynamic Message Signs - MDOT

 

 

 

 

 

 

 

 

 

 

 

 

INITIAL EFFECTIVE DATE

 

 

INITIAL EXPIRATION

 

 

 

INITIAL AVAILABLE

 

 

EXPIRATION DATE BEFORE CHANGE(S)

 

 

 

 

 

 

DATE

 

 

 

 

OPTIONS

 

 

 

 

 

 

 

NOTED BELOW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July 21, 2009

 

 

 

July 20, 2012

 

 

 

 

2, one year

 

 

 

 

 

 

 

July 20, 2013

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT TERMS

 

 

 

F.O.B

 

 

 

SHIPPED

 

 

 

SHIPPED FROM

 

 

 

 

Net 45 ARO

 

 

 

Delivered

 

 

 

90-120 Days ARO

 

 

 

 

 

 

Canada

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALTERNATE PAYMENT OPTIONS:

 

 

 

 

 

 

 

 

 

AVAILABLE TO MiDEAL PARTICIPANTS

 

 

 

 

P-card

Direct Voucher (DV)

 

 

 

 

Other

 

 

 

Yes

 

No

 

 

 

MINIMUM DELIVERY REQUIREMENTS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Unit

DESCRIPTION OF CHANGE NOTICE:

EXTEND CONTRACT

EXERCISE CONTRACT

EXTENSION BEYOND

LENGTH OF

EXPIRATION DATE

EXPIRATION DATE

OPTION YEAR(S)

CONTRACT OPTION YEARS

OPTION/EXTENSION

AFTER CHANGE

No

Yes

 

 

1 year

July 20, 2014

VALUE/COST OF CHANGE NOTICE:

ESTIMATED REVISED AGGREGATE CONTRACT VALUE:

$0.00

$4,252,808.00

Effective June 12, 2013, the contract exercises an option year. New contract end date is July 20, 2014

Form No. DTMB-3521 (Rev. 4/2012)

AUTHORITY: Act 431 of 1984

COMPLETION: Required

PENALTY: Contract change will not be executed unless form is filed

STATE OF MICHIGAN

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET June 28, 2012

PROCUREMENT

P.O. BOX 30026, LANSING, MI 48909

OR

530 W. ALLEGAN, LANSING, MI 48933

CHANGE NOTICE NO. 2

to

CONTRACT NO. 071B9200263

between

THE STATE OF MICHIGAN

and

NAME & ADDRESS OF CONTRACTOR:

PRIMARY CONTACT

EMAIL

 

 

 

Ledstar, Inc.

 

 

 

 

Milan Patel

 

 

milan@ledstar.com

 

131 Westcreek Drive

 

 

 

 

TELEPHONE

 

 

CONTRACTOR #, MAIL CODE

 

Woodbridge Ontario, L4L 9N6

 

 

(905) 265-7800 Ext. 206

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE CONTACTS

 

AGENCY

 

 

NAME

PHONE

 

EMAIL

 

CONTRACT COMPLIANCE

 

MDOT

 

Michele Mueller

(248) 431-1443

 

 

muellerm2@michigan.gov

 

INSPECTOR:

 

 

 

 

 

 

 

 

 

 

Don

 

 

 

 

 

BUYER:

 

DTMB

 

Mandernach

(517) 241-7233

 

 

mandernachd@michigan.gov

 

CONTRACT SUMMARY:

DESCRIPTION: Dynamic Message Signs - MDOT

INITIAL EFFECTIVE

INITIAL

AVAILABLE

 

 

DATE

EXPIRATION DATE

OPTIONS

CURRENT EXPIRATION DATE

7/21/2009

7/20/2012

2, 1 Yr. Options

7/20/2012

 

PAYMENT TERMS

F.O.B

SHIPPED

SHIPPED FROM

 

Net 45 ARO

Delivered

90 - 120 Days ARO

Canada

 

ALTERNATE PAYMENT OPTIONS:

 

AVAILABLE TO MiDEAL PARTICIPANTS

P-card

Direct Voucher (DV)

Other

YES

NO

MINIMUM DELIVERY REQUIREMENTS:

1 Unit

DESCRIPTION OF CHANGE NOTICE:

OPTION EXERCISED:

NO

YES

IF YES,EFFECTIVE DATE OF CHANGE:

7/21/2012

NEW EXPIRATION DATE:

7/20/2013

Effective immediately, the first of the two available option years will be utilized.

All other terms, condition, specifications, and pricing remain the same.

Per agency (ITRAC request C20120618-093821 dated 6/27/2012) and Vendor (dated 6/28/2012) agreement, and DTMB Procurement approval.

VALUE/COST OF CHANGE NOTICE:

$0.00

ESTIMATED REVISED AGGREGATE CONTRACT VALUE:

$4,252,808.00

Form No. DMB 234 (Rev. 1/96)

AUTHORITY: Act 431 of 1984

COMPLETION: Required

PENALTY: Contract will not be executed unless form is filed

STATE OF MICHIGAN

DEPARTMENT OF MANAGEMENT AND BUDGET November 8, 2011

PROCUREMENT

P.O. BOX 30026, LANSING, MI 48909

OR

530 W. ALLEGAN, LANSING, MI 48933

CHANGE NOTICE NO. 1

OF

CONTRACT NO. 071B9200263 between

THE STATE OF MICHIGAN

and

NAME & ADDRESS OF CONTRACTOR

Ledstar, Inc.

131 Westcreek Drive

Woodbridge Ontario, L4L 9N6

Email: Milan@ledstar.com

TELEPHONE Milan Patel

(905) 265-7800 Ext. 206

CONTRACTOR NUMBER/MAIL CODE

BUYER/CA (517) 373-7374

Klatra Pickett

Contract Compliance Inspector: Michelle R. Mueller: muellerm2@michigan.gov (248-483-5133)

Dynamic Message Signs – MDOT

CONTRACT PERIOD: 3 yrs. + 2 one-year options

From: July 21, 2009

To: July 20, 2012

TERMS

 

SHIPMENT

 

Net 45 ARO

 

 

90 to 120 Days ARO

F.O.B.

 

SHIPPED FROM

Delivered

 

 

Canada

MINIMUM DELIVERY REQUIREMENTS

1 Unit

MISCELLANEOUS INFORMATION:

NATURE OF CHANGE(S):

For maintenance access, currently the large dynamic message signs are not set up for rear door entry. On October 21, 2011, the Michigan Department of Transportation (MDOT) received additional federal funding for eight (8) custom rear door access (parts and labor) and design, engineering and drawings. This contract will be INCREASED by $14,658.00. This is allowed under current contract language.

All other terms, conditions, specifications, and pricing remain unchanged.

AUTHORITY/REASON(S):

Per Purchase Request (PRF) from MDOT, dated 10/12/2011.

INCREASE: $14,658.00

TOTAL REVISED ESTIMATED CONTRACT VALUE: $4,252,808.00

Form No. DMB 234 (Rev. 1/96)

AUTHORITY: Act 431 of 1984

COMPLETION: Required

PENALTY: Contract will not be executed unless form is filed

STATE OF MICHIGAN

DEPARTMENT OF MANAGEMENT AND BUDGET

PURCHASING OPERATIONS

P.O. BOX 30026, LANSING, MI 48909

OR

530 W. ALLEGAN, LANSING, MI 48933

CONTRACT NO.

 

071B9200263

 

between

 

 

THE STATE OF MICHIGAN

 

and

 

 

NAME & ADDRESS OF CONTRACTOR

 

 

TELEPHONE Milan Patel

 

 

 

(905) 265-7800 Ext. 206

Ledstar, Inc.

 

 

CONTRACTOR NUMBER/MAIL CODE

131 Westcreek Drive

 

 

 

 

Woodbridge Ontario, L4L 9N6

 

 

BUYER/CA (517) 241-2619

Email: Milan@ledstar.com

Seleana Samuel

Contract Compliance Inspector: Michelle R. Mueller: muellerm2@michigan.gov (248-483-5133)

Dynamic Message Signs – MDOT

CONTRACT PERIOD: 3 yrs. + 2 one-year options

From: July 21, 2009

To: July 20, 2012

TERMS

 

SHIPMENT

 

Net 45 ARO

 

 

90 to 120 Days ARO

F.O.B.

 

SHIPPED FROM

Delivered

 

 

Canada

MINIMUM DELIVERY REQUIREMENTS

1 Unit

MISCELLANEOUS INFORMATION:

The terms and conditions of this Contract are those of ITB #071I9200147, this Contract Agreement and the vendor's quote dated April 4, 2009. In the event of any conflicts between the specifications, and terms and conditions, indicated by the State and those indicated by the vendor, those of the State take precedence.

Estimated Contract Value: $4,238,150.00

THIS IS NOT AN ORDER: This Contract Agreement is awarded on the basis of our inquiry bearing the ITB No. 071I9200147. Orders for delivery will be issued directly by the Department of Transportation through the issuance of a Purchase Order Form.

All terms and conditions of the invitation to bid are made a part hereof.

FOR THE CONTRACTOR:

Ledstar, Inc.

Firm Name

Authorized Agent Signature

Authorized Agent (Print or Type)

Date

FOR THE STATE:

Signature

Anthony DesChenes, Director

Name/Title

Commodities Division, Purchasing

Operations

Division

Date