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Home My WebLink AboutContract 50014-CO1 FORT WORTH. City of Fort Worth aAW Change Order Request CONTRACT:._ I Project Namel HMAC Street Rehab at Multiple Locations(2017-4) City Sec# 1 50014 Client Project#(s)l 100744, 100747 Change Order Submittal# 0 Date 2/14/2018 Contract Time Dept. TPW Totals CD Original Contract Amount $501,676.45 $501,676.45 90 Extras to Date Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $501,676.45 $501,676.45 90 Amount of Proposed Change Order $82,621.00 $82,621.00 30 Revised Contract Amount $584,297.45 $584,297.45 120 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 Additional Funding(if necessary) $82,621.00 $82,621.00 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 16.47% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $627,095.56 : . F4gSTIFIGATI}I ON$)FOR GHANGE RQER Y r. An additional pay item is required for combination sidewalk on Pate -\O 11 12 q Rf y• ��Ep j co R� Etr23 2010 w N � ^rFTIAL RECORD 6 00 Cf*rY . �TARY �dzc �4o�6 FT.lilt% iktHq TX FORTWORTH City of Fort Worth Change Order Additions Project Name HMAC Street Rehab at Multiple Locations(2017-4) City Sec# 50014 Client Project# 100744,100747 Change Order Submittal# Date 2/14/2018 ADDITIONS ITEM L)LbUKIf'I IUN DEPT Q)( Unit nit Cost I o a new om ina on SORT TPW $82,621.00 Sub Total Additions $82,b21.UUJ Change Order Additions Page 1 of 1 FOR. OR H City of Fort worth Change Order Deletions Project Name HMAC Street Rehab at Multiple Locations(20171) City Sec# 50014 Client Project# 100744,100747 Change Order Submittal# 0 Date 2/14/2018 DELETIONS ITEM DESCRIPTION DEPT Qty Unit Unit os o a TPW $0.00 Sub Total Deletions 0.00 Change Order Deletions Page 1 of 1 MISBE Breakdown for this Change Order MISBE Sub Type of Service Amount for this CO Zamora Construction Concrete Flatwork $75,110.00 Total $75,110.00 Previous Change Orders CO# DATE AMOUNT Total $0.00 City of Fort Worth ACCEPTANCE OF PREVIOUS MBE COMMITMENT FORM (for use with CHANGE ORDERS or AMENDMENTS greater than$50,000) To be Completed by City Project Manager - -. :Ghange Order(fQr.Constr-uction_Gantrac#).- .: .. .. .. . . Project Name: City Project Number 100744 HMAC 20174 Street Rehabilitation City Protect Manager Contractor; . ; Kristian Sugrim JLB Contracting, LLC. City's MBE Project°Goal:: 8 SS .Original Amount of Con#tact: $501,676.45 Accepted MBE Commitment: 9 Totafof-Previous Change Orders $0.00 Date of Last MBE Report: Amount for:this Change Order: $82,621.00 :Change Order Revised Amount of Contract: $584,297.45 ..Date: 2/15/2018 Language to be inserted in the M&C for this Contract JLB Contracting, LLC. agrees to maintain its initial MBE commitment of 9%that it made on the original contract and extend and maintain that same MBE commitment of 9%to this first change order. Therefore JLB Contracting, LLC. remains in compliance with the City's BIDE Ordinance and attests.to its commitment by its signature on the Acceptance of Previous MBE Commitment form executed by an authorized representative of its company. To be Completed by the Representative of th=Cont tor Sam Davis President 2/15/18 Printed Signature Title Authorized Signature/Date JLB Contracting, LLC. Company Name Contact Name(if different) PO Box 24131 sdavis@jlbcontracting.com Address E-mail address Fort Worth, Texas 76124 817-261-2991 817-261-3044 City/State/Zip Phone number Fax Number 0% as of 2/15/18 MBE%Paid to Date Date City Project anager has revie.weaThe.worc assodi.ated associatedwith this : han e: rder, considers it the same or similar to work in.the original Contract, and recommends that the .Contractor have the option.to retain_ d co m its existing MBE commitment. Kristian Sugrim 15 8 City.Project.Manager CIty Project Man.ger S)griature ate A ttach Complete Change Order Documentation and Forward to MIWBE office To be Completed by • • �YlR k n� Va l lc O l' � M/WBE Complia a Staff iD# MBE Current%Level via Last Report Rec'd 64 M/WBE Signature Date CFW Change Order Approval St-COApp01 Page 1 of 3 Routing Assigned To: Due Date: Assigned By: Due Time: Links 2 fortworthgov/Infrastructure Proiects/100744 - Pate Drive (Coleman to Berry)/Contractor/Change Orders/change order 1 - combination sidewalk on Pate fortworthgov/Infrastructure Proiects/100744- Pate Drive (Coleman to Berry)/Contractor/Change Orders/H2O17-4 APCF 1007441.1)df Attachments(0) No Attachments have been added to this form. https://projectpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?SiteId=51500&ProcessI... 2/28/2018 CFW Change Order Approval St-COApp01 Page 2 of 3 FORT WORTHO City of Fort Worth --.. fir•- -- Change Order Request Approval (Change Order Breakdown Available in Links) For Change Order Submittal No.: 1 Change Order No.: St-COApp01 Date Started: 2018-02-19 City Sec. No.: 50014 Date Due: 2018-04-10 Project Name: 100744 - Pate Drive (Coleman to Berry) 100744 DOE Numbers: Project Numbers: Project Removal and replacement of nonfunctional driveways, sidewalks Description: and curb & gutters; followed by the pulverization and stabilization of the existing pavement and a 2" HMAC overlay, Project Manager: Kristian Sugrim City Inspector: Mark Owen Contractor: JLB Contracting, LLC. COUNCIL ACTION (If Required): M&C Log Name: M&C Number: M&C Date: COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW $ 82,621.00 39406-0200431-5740010-100744-0 30 Total Cost: $ 82,621.00 Total Requested Days: 30 Approval Status: https://projectpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?Siteld=51500&ProcessI... 2/28/2018 CFW Change Order Approval St-COApp01 Page 3 of 3 Approved: Yes Comments: User: Sam Davis Date: 2018-02-19 5:48 PM Approved: Yes Comments: User: Kristian Sugrim Date: 2018-02-20 1:15 PM Approved: Yes Comments: User: Lane Zarate Date: 2018-02-21 3:00 PM Approved: Yes Comments: User: Ricardo Matute Date: 2018-02-21 11:24 AM Approved: Yes Comments: User: Doug Wiersig Date: 2018-02-21 2:06 PM Approved: Yes Comments: User: Doug Black Date: 2018-02-27 5:26 PM Approved: Yes Comments: User: Jay Chapa Date: 2018-02-28 9:36 AM Action Required: 2 1VIa J. 14a1W,TiiS OFFICIAL RErFiRD 'cx '' CITY SECR1774IRY AS FT.WORT,, t Y.- https://projectpoint.buzzsaw.com/ bz web/Forms/Fon Print.aspx?Siteld=51500&ProcessI... 2/28/2018 Contract Compliance Manager Re: Change Order No. 1 ($82,621.00) Contractor: JLB Contracting, LLC. Project Name: HMAC 2017-4 Street Rehab. City Secretary No.: 50014 Project No.: 100744/100747 By signing, I acknowledge that I am the person responsible for the monitoring and administration of this contract including ensuring all performance and reporting requirements. _ Name of Employee QS Project Manager Title 101� y�Q� RECEIVED FEB 2 3 2018 CITY Or-FORT WORTH CITY SECRETARY