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'CFW Change Order Approval St-COApp10 Page 2 of 3
CITY
FORT WORTM,
City of Fort Worth CONTRACT NO.SECRETARY�I_"
Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal No.:f 5
Change Order No.: St-COApp10 Date Started: 2017-09-29
City Sec. No.:W349Date Due: 2017-10-13
Project Name: N. Beach Street from NE Loop 820 to Fossil Creek
Proect Numbers: 02238 ^DOE Numbers:
j - - -
7237
Project 'Widen N. Beach Street to a 6-lane divided arterial street with
Description: paving, drainage, sidewalks, water, sewer, traffic signal,
illumination, landscape and irrigation improvments.
Project Manager: Michael Weiss City Inspector: Tom Miller
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 $ 9,375.00 34014 0200431 5740010 CO2238 0J 0
Total Cost: $_9,375.00 Total Requested Days: 0
Approval Status:
Al
RECEIVED
9 ;1)11
CITY OF FORT WORTH OFFICIAL RECORD
CffY SECRETARY CITY SECRETARY
FT.WORTH,TX
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•CF'W Change Order Approval St-COApp10 Page 3 of 3
Approved: Yes
Comments:
Usef: Aaron Perez
Date: 2017-09-29 10:18 AM
Approved: Yes
Comments:
User: Michael Weiss
Date: 2017-09-29 10:21 AM
Approved: Yes
Comments:
User: JoAnne Kamman
Date: 2017-09-29 1:40 PM
Approved: Yes
Comments:
User: Kim Arnold
Date: 2017-09-29 3:46 PM
Approved: Yes
;Comments:
;User: Doug Wiersig
Pate: 2017-10-02 2:05 PM FORT w�
�O. 'P=
(Approved: Yes b 1'
Comments: y�
User: Doug Black
Date: 2017-10-06 3:38 PM ''cam
I, J. Kayser, City cretary 'TEXp'`
;Approved: Yes
(Comments:
User: Jay Chapa
]Date: 2017-10-09 9:51 AM
I
Action Required:
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible for
" the monitoring and administration of this contract,including
ensuring all performance and reporting requirements.
Michael Weiss,P.E. ._...
Senior Professional Engineer
OFFICIAL RECORD
CITY SECRETARY
FT.WORTlH$TX
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a
,CFW Change Order Approval St-COApp10 Page 1 of
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthgov/Infrastructure Proiects/02238 - N. Beach Street from NE Loop 820 to Fossil Creek/Contractor/Change Orders/Change Order
Breakdown template cos, solar powered controller- 8.29.2017.xism
Attachments(01
No Attachments have been added to this form.
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FORT WORTH_ City of Fort Worth
Change Order Request Breakdown
ProjectNarnel N.Beach Street from Fossil Creek to NE Loop 820 City Sec# 1 47349
Client Project#(s)l 02238
Change Order Submittal# 0 Date 8/29/2017
Dept. T/PW Water Sewer Contract Time
Totals CD
Original Contract Amount $5,675,296.15 $89,335.52 $82,214.26 $5,846,845.93 541
Extras to Date $167,223.79 $0.00 $0.00 $167,223.79 14
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $5,842,519.94 $89,335.52 $82,214.26 $6,014,069.72 555
Amount of Proposed Change Order $9,375.00 $0.00 $0.00 $9,375.00 0
Revised Contract Amount $5,851,894.94 $89,335.52 $82,214.26 $6,023,444.72 555
Original Funds Available for Change Orders $488,154.00 $6,250.00 $5,750.00 $500,154.00
Remaining Funds Available for this CO $320,930.21 $6,250.00 $5,750.00 $332,930.21
Additional Funding(if necessary)
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 3.020/6
MAXALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $7,308,557.41
JUSTIFICATION (REASONS) FOR CHAoNGE ORDER
Due to missing information on the irrigation lans,a solar powered controller is needed to operate the installed
' g p p _ p ailed irrigation system.
FORT WORTH City of Fort worth
Change Order Additions
Project Name N.Beach Street from Fossil Creek to NE Loop 820 City Sec# 47349
Client Project# 02238
Change Order Submittal# L� Date 8/29/2017
ADDITIONS
Qty Unit Unit Cost I ota
9999.0000 Irrigation ystem ns abon
TMW-
TIPW $9,375.00
Water $0.00
Sewer $0.00
Sub I otal Additions 9,3T
Change Order Additions Page 1 of 1
FORTWORTH City of Fort worth
— — Change Order Deletions
Project Name N.Beach Street from fossil Creek to NE Loop 820 City Sec# 47349
ClientProject# 02238
Change Order Submittal# 0 Date 8/29/2017
DELETIONS
ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total
T/PW $0.00
Water $0.00
Sewer $0.00
Sub Total Deletions
Change Order Deletions Page 1 of 1