HomeMy WebLinkAboutContract 45392-CO4 CF W Change Order Approval St-COApp05 Page 2 of 3
CITY SECRFTAW d1r,
FORT WORTH. city of Fort Worth CoWPACT NO.—
Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal No.: 4
Change Order No.: St-COApp05 Date Started: 2015-06-16
City Sec. No.: 45392 Date Due: 2015-08-05
Project Name: 2010 Intersection Improvements Contract 1
01652 DOE Numbers:
Project Numbers:
7003
Project Intersection Improvements at 3 inteersections in North Forth
Description: worth
Project Manager: Lissette Acevedo City Inspector: Mike Collier
Contractor: JLB Contracting, Inc
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 $ 800.00 C295-541200-202390165280 0
Total Cost: $ 800.00 Total Requested Days: 0
Approval Status:
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CFW Change Order Approval St-COApp05 Page 3 of 3
Approved: Yes
Comments:
User: Sam Davis
Date: 2015-06-17 7:48 AM
Approved: Yes
Comments:
User: Todd Estes
Date: 2015-06-17 8:40 AM
Approved: Yes
Comments:
User: Andy Anderson
Date: 2015-06-17 1:09 PM
Approved: Yes
Comments:
User: Doug Wiersig
Date: 2015-06-17 4:54 PM
Approved: Yes
Comments:
User: Doug Black
Date: 2015-06-17 5:39 PM
Approved: Yes
Comments:
User: Fernando Costa
Date: 2015-06-17 10:50 PM
Action Required: 0� F01?
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M&C REQUIRED
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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FORT WORTH. City of Fort Worth
Change Order Request Breakdown
Project Namel North Fort Worth Intersection Improvements-Phase 1 City Sec#
Client Project#(s)l DOE 7003; File No.K-2990;City Project 01652
Change Order Submittal# ® Date 2/412015
Dept. T/PW Contract Time
Totals CD
Original Contract Amount $451,106.89 $451,106.89 180
Extras to Date $107,866.17 $107,866.17 142
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $558,973.06 $558,973.06 322
Amount of Proposed Change Order $800.00 $800.00
Revised Contract Amount $559,773.06 $559,773.06 322
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) E $800.00 $800.00
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 24.09%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $563,883.61
JUSTIFICATION(REASONS)FOR CHANGE ORDER
Change order required to install asphalt drive approach at SE comer of Alta Vista&SH170.
CFW Change Order Approval St-COApp05 Page 1 of 3
Routin
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthaov/Infrastructure Proiects/01652 - 2010 Intersection Improvements Contract 1/Contractor/Chance
Orders/Chance Order Breakdown co4.xls
Attachments(0)
No Attachments have been added to this form.
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