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Home My WebLink AboutContract 50133-CO1 CITY SECRETARY FORT WORTH. City of Fort Worth CONTRACT NO. 1� Change Order Request Breakdown ProjectNamel TRAFFIC SIGNAL MAINTENANCE City Sec# 1 50133 Client Project#(s)l C10205 Contractorl SIEMENS INDUSTRY INC. PM Inspector Change Order Submittal# 0 Date 8/8/2018 Dept. TPW Contract Time Totals CD Original Contract Amount $95,000.00 $95,000.00 Extras to Date Credits to Date Pending Change Orders(in MSC Process) Contract Cost to Date $95,000.00 $95,000.00 Amount of Proposed Change Order $6.00 Revised Contract Amount $95,000.00 $95,009.00 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 Additional Funding(if necessary) CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 0.00% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+259K.) $118,750.00 Adding new bid items to cover unforeseen work to be completed. 0 OFFICIAL RECORD CITY SECRETARY F'S•WORTH, TX City of Fort Worth Change Order Additions Project Name TRAFFIC SIGNAL MAINTENANCE City Sec# 50133 Client Project# C10205 Contractor SIEMENS INDUSTRY INC. PM Inspector Change Order Submittal# u Date B/6/2018 ADDITIONS HEM DESCRIPTION DEPT tynit Cost Total 34 500.00000000 35 75. 0 0 3 000 7 INSTALL AWG MULTI-CONDUCTORCABLE ionoomoo 38 INSTALL 3l 1 AWG MULTI-CONDUCTOR ABLE . 0 000 0 nit 39 INSTALL 5/C 14 AWG MULTI-CON DU TOR ABLE 1,206.00000000 40 INSTALL 7/C 14A MULTI-CONDUCTOR ABL 0 . 0 41 REPLACE 21C 14 AWG MULTI-CONDUCTOR CABLE 500.00000000 2 REPLACE 31C 14 AVVG MULTI-CONDUCTOR CABLE 1,400.000000002. 0 43 REPLACE 5/C 14 AWG MULTI-CONDUCTOR CABLE 1,00moomoo REPLACE 7/C 14 AWG MULTI-CONDUCTOR CABLE 5 INSTALL 3-SEC I NAL HEAD ASSEMBLY 12 . EA 9. 0 46 INSTALL 4-SEC SIGNAL HEAD ASSEMBLY 0. EA $319.00 7 INSTALL 5-SEC IGNAL HEAD ASSEMBLY 1 0 EA 46 DM HOUSE RVERTICAL REMOVE XSEC SIGNAL HEAD ASSEMBLY 1 EA 50. REMOVE 4-SEC SIGNAL HEAD ASSEMBLY 1 . 0 00 EA 50. 51 REMOVE 5-SEC SIGNAL HEADA EMBLY 1 EA 5 . 52 DOG HOUSE R VERTICAL TPW 5 REPLA E SIGNAL HEAD ASSEMBLY200.000EA 1 . 4 REPLACE 4-SEC SIGNAL HEAD ASSEMBLY 20.00000000 EA 6 55 REPLACE 5-SEC SIGNAL HEAD A MBL 10. EA $4197 56 DOG HOUSE R VERTICAL 57 REMOVE ILLUMIMATI N FUSE HOLDER 10.00 0 0 EA 10.0 58 INSTA L ILLUMINATION FUSE HOLDER 10. 00 EA 9 REPLACE ILLUMINATION FUSE HOLDER TPW 10.00000000 EA $25.00 60 REMOVE NO 10 INSULATED ELECTORNDU T R TPW ___3MM. MM LF 1 INSTALL NO 10 INSULATED ELECTOR CONDUTOR 300,00000000 LF 1. REPLACE INSULATED ELECTOR CONDUCTOR0 . 0 LF REMOVE METR I N 35.00000000 EA 0 64 INSTALL METRO SIGN(MAST ARM ORCANTILEVE ) 36.00000000 EA 4 5 REPLACE METRO N(MAST ARM OR CANTILEVER) 36,00000000 EA INSTALL ANTILEVER TPW 30.00000000EA $300.00 7 INSTALL N 20.00 EA 63 REMOVE SIG,\1 20.00000000 EA 20.00 69 REPLACE SIGN 00-.0-00-0700- EA 4. 70 TRAFFIC I A TROUBLESHOOTING 5.0 .5 HR 45. TPW $189,136.00 ub Total Additions 18 ,1 Change Order Additions Page 1 of 1 F RT WORTH City of Fort Worth Change Order Deletions Project Name TRAFFIC SIGNAL MAINTENANCE City Sec# 50133 Client Project# C10205 Contractor SIEMENS INDUSTRY INC. PM Inspector Change Order Submittal Date 8/6/2018 DELETIONS HEM UIESCRIP I ON DEPT Qty Unit Unit Cost I oto 1 REMOVE VEHICULAR SIGNAL LED I`vv 2 INSTALL VEHICULAR NAL L D TPW 518. b. , REPLACE VEHICULARI NAL LED T15W 5 . REMOVEPEDESTRIAN SIGNAL LED 7p—w 5 INSTALL PEDESTRIAN D 7 m- 6 REPLACE PEDESTRIAN I NAL LED REMOVE HICULAR SIGNAL 3 SECTION HEAD T W — 138.00000000 $107.00 $14,766.00 INSTALL VEHICULARSUAL N HEAD TPW LA I AL TSECTiON HEAD TPW REMOVE H NA N HEAD P 7. 19 INSTALL VEHICULAR SIGNAL 4 SECTION HEADP , c . LA VEHICULAR SIGNAL 4 SECTION HEAD TPW 11.00000000 —MOVE21 -THICULAR SIGNAL 5 SECTIONHEAD(D HUE 07 V TI TPW 12.00000001) INSTALL VEHICULAR SIGNAL 5 SECTION HEAD(D H U R v=i TPw 12.00000000 EA $213.uu �Z,bbb.uu REPLACE VEHICULAR SIGNAL 5 SECTION H ( H U E R ITP 24 REMOVE VEHICULAR SIGNAL BACKLA TPW 160,00000000 5INSTALL VEHICULAR N A PW 26 REPLACE VEHICULAR I AL BACK PLATEW TPW $189,136.00 bub Total Deletions Change Order Deletions Page 1 of 1 M/SBE Breakdown for this Change Order M/SBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders co# DATE AMOUNT Total $0.00 CFW Change Order Approval 1 Page 1 of 4 Routin Assigned To: Due Date: Assigned By: Due Time: Links 1 fortworthgov/Infrastructure Projects/100869 -Traffic Signal Preventative Maintenance Contract 1/Contractor/Change Orders/Change Order Breakdown.xlsm Attachments(0) - - - -No Attachments have been added to this form. https://projectpoint.buzzsaw.com/ bz_web/Forms/FonuPrint.aspx?Siteld=51500&Proces... 10/17/2018 CFW Change Order Approval 1 Page 2 of 4 FORT NORTH© City of Fort Worth f•.. Change Order, Request Approval (Change Order Breakdown Available in Links) For Change Order Submittal No.: 1 Change Order No.: 1 Date Started: 2018-08-06 City Sec. No.: 50133 Date Due: 2018-09-25 Project Name: State Signal Maintenance 10205 DOE Numbers: Project Numbers: Project Miscellaneous traffic signal maintenance activities at traffic Description: signals on TxDOT roadway Project/Contract Compliance Scott Arnold City Inspector: Lee Soria Manager: Contractor: COUNCIL ACTION (If Required): M&C Log Name: M&C Number: M&C Date: COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW $ 0.00 Total Cost: $ 0.00 Total Requested Days: 0 Approval Status: https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Siteld=51500&Proces... 10/17/2018 CFW Change Order Approval 1 Page 3 of 4 Approved: Yes Comments: User: Michelle Flynn Date: 2018-08-27 6:12 PM Approved: Yes Comments: User: Scott Arnold Date: 2018-08-27 1:24 PM Approved: Yes Comments: User: Ali Mozdbar Date: 2018-08-27 6:41 PM Approved: Yes Comments: User: Michelle Flynn Date: 2018-09-04 8:04 PM Approved: Yes Comments: User: Scott Arnold Date: 2018-09-04 3:12 PM Approved: Yes Comments: pRT User: Ali Mozdbar Date: 2018-09-05 8:02 PM Approved: Yes Comments: User: Richard Martinez Date: 2018-10-01 5:02 PM M J. K er, Secretary Approved: Yes Comments: User: Doug Wiersig Date: 2018-10-15 7:22 PM &p°+ Approved: Yes 1 P295: Comments: User: Doug Black Date: 2018-10-17 4:09 PM OFFICIAL RECORD Approved: Yes CITY3ECRETARY Comments: F,T. waRT",TX https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?SiteId=51500&Proces... 10/17/2018 CFW Change Order Approval 1 Page 4 of 4 User: Susan Alanis Date: 2018-10-17 1:42 PM Action Required: [1G3FFJC:1A'LRE(CGRDTY ARYT. r -ex https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?SiteId=51500&Proces... 10/17/2018 Contract Compliance Manager: 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. G k.144 Name of Employee/Signature S' �''Kw� --,� „�z� Title F1 This form is N/A as No City Funds are associated with this Contract Printed Name Signature EOFFICIALECORD ETARY H,TX