HomeMy WebLinkAboutContract 54211-CO1CSC No. 54211-CO1
FORT W(,R�'H City of Fort Worth
� �"�',y -�- Change Order Request
Projecf Name:� 2020 Miscellaneous Sanilary 5ewer Manhole Repair Confrac( Cily 5ec No.: r,542 11 �
Projecf No.(s):� 56002 0700430-102639 001700 � M&C: 20-0458 City Proj. No 102 639 _^_ �
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Projecl Oescnr,lion� Miscellaneous Sanilary Sewer Manhole Repairs fhroughoul lhe City of Forl Worlh
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Contraclor. Ace Pipe Cleaning, Inc Change0rder# r 1 Dale: I 5121/2021
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Cily Project Mgr � J. Chris Underwood_� Cily Inspeclor. Cody Dale Gair ,
PhoneNumber:� 817`392-2629 --� PhaneNumber:� 817-713-3074
De t, Water Sewer Pavin Totals Contract Time
P � + � � g � � (Calender daysJ �
Original ContractAmoun� $225,000.00
Exfras to Date
Credifs to Dafe
Pending Change Orders (in M�C Process)
Contracl Cosl lo Dale $225,000.00
Amount of Proposed Change Order � �$782.70
Revised Contracl Amount $228,782.70
Original Funds Available for Change Orders
Remaining Funds Available for Ihis CO
Addilional Funding (if necessary) $782.70
CNANGE ORDERS to DATE (INCLUDING THlS ONE) A5 % Of ORIGINAL CONTRACT
MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST + 25%J
Inspector
•iG �� �
Assislant Dire
-�stv�,(ur Kar-Jer
Ass(slanl Cily
M8C Number NIA
Oale Proj�na�er _�
�5/�v/ry l
Oale oGonsl n Su er ' r{V
ay 25, 2021
Date Assistant aneger
u n 8, 2021 �
�ouncll Acqon (If Requlred)
M8C Date Approved
782.70
J $782.70' �
0.35°�
$281,250.00
Dale
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ate
.��3��x,z/
�ate
OFFICIAL REC�RD
CITY SECRETARY
FT. VIIORTH, TX
in full (bolh lime and money) for all cosls arising oul of, or incidenfal lo, lhe above Change Order.
Eonlraclor's Company Name Conlraclor Name ,Conlrac�of�. i�n�—iure � Dale ,
Ace Pipe Geanin�, Inr. Theresa Calvert ��_ �, � l_tisi �,�2 .
�'�) RT �WC� RT i-� City of Fort Worth
—" -- - Change Order Additions
Projecl Name 2020 Miscellaneous Sanitary Sewer Manhole Repair Conlracl I Cily Sec No.: 54211 J
Projecl No.(s): � 56002-0700430-102639-001780 � DOE No 20-045 Cily Proj. No. �_ 102639 1
Projecf Miscellaneous Sanitary Sewer Manhole Repairs lhroughou� llie City of Fort Worth
Descriplion
Conlractor Ace Pi e Cleanin Inc � Chan e Order. 1 Date: 5121f2021
� p 9 -- --� 9 ��� _� ^ � —
Cily Project Mgr. J, Chris Underwood Cily Inspeclor I Cody Dale Gair _ (
ADQITIONS
F() RT W(� RT H City of Fort Worth
-�-- � Change Order Deletions
Projecl Name 2020 Miscellaneous Sanifary Sewer Manhole Repair Con fr�l _ —� Cily Sec No.: L54211 _�
Project No,(s): � 56002-0700430-102639-001780 —� DOE No. 20-04 Cily Proj. No. I 102639 __l
Projecl Descriplion I Miscellaneous Sanitary Sewer Manhole Repairs Ihroughoul the City of Forl Worlh �_ I
Conlraclor � Ace Pipe Cleaning, Inc Change Order. �1 Dale � 5121l2021 _�
Cify Projecf Mgr. f J. Chris Underwood City Inspeclor. Cody Dale Gair
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DELETIONS
M/WBE Breakdown for this Change Order
._ _ _.�,��_.�_____�___...____ �. ___�__. _ �_ _...,
MWBE Sub Type of Service Amount for fhis CO
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Total $0.00
Page 4 of 4
Previous Change Orders
Con�rac� Compliance Mana�er
By signing I acknowledge that I am the person responsible
for the monitoring and admiuistraiion of ihis contract, including
enstu�ing all performance an.d reporting requirements.
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S gnafure
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Nam.a of Employea
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Title
ATTEST:
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Mary J. Kayser
City Secrefiary
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Signature:
Email: Dana.Burghdoff@fortworthtexas.gov
OFFICIAL REC�RD
CITY SECRETARY
FT. VIIORTH, TX