HomeMy WebLinkAboutContract 46585-CO1 CITY SECRETARY .�
FORT WORTH® City of Fort Worth CONTRACT NO..
Change Order Request Breakdown
Project Namel HMAC STREET REHAB(2015-1) City Sec# 1 46585
Client Project#(s)i CPN 02423;DOE 7384
Contractorl JLB Contracting PM K.Sughm Inspector G.Deyon
Change Order Submittal# 0 Date 1/23/2018
Dept. T/PW Water Sewer Contract Time
Totals CD
Original Contract Amount $833,545.84 $416,772.92 $416,772.92 $1,667,091.68 210
Extras to Date
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $833,545.84 $416,772.92 $416,772.92 $1,667,091.68 210
Go to ADD&DEL Tabs to Enter CO Backup $0.00 $0.00 $0.00 271
Revised Contract Amount $833,545.84 $416,772.92 $416,772.92 $1,667,091,68 481
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00 $0.00 $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+25%) $2,083,864.60
Additional time is required for the rehabilitation of Meadowbrook Dr.(Beach St.-Haynes Ave.)which was delayed from water and gas conflicts
and compounded by a procedural change for Fire Station 14.
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Change Order Additions
Project Name HMAC STREET REHAB(2015-1) CitySec# 46585
Client Project# CPN 02423;DOE 7384
Contractor JLB Contracting PM K.Sugrim Inspector G.Deyon
Change Order Submittal# 0 Date 1/23/2018
ADDITIONS
-ITEM DESCRIPTION DEPT Qty Unit U I Cost Total
T/PW $0.00
Water $0.00
Sewer $0.00
Sub Total Additions
Change Order Additions Page 1 of 1
FORTT WWORTH City of Fort worth
Change Order Deletions
Project Name HMAC STREET REHAB 2015-1) CitySec# 46585
Client Project# CPN 02423;DOE 7384
Contractor JLB Contracting PM K.Sugrim Inspector G Deyon
Change Order Submittal# 0 Date 1/2312018
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
MISBE 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 $0.00
CFW Change Order Approval St-COApp02 Page 1 of 3
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthaov/Infrastructure Proiects/02423 - HMAC Street Rehabilitation 2015-1/Contractor/Change Orders/H2O15-1
Change Order Breakdown DOE 7384- additional time.xls
Attachments(91
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CFW Change Order Approval St-COApp02 Page 2 of 3
FORT WORTS, City of Fort Worth
Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal No..
:....................................................
Change Order No.: St-COApp02 Date Started: 12018-01-31
City Sec. No.: Date Due: ,2018-03-22
Project Name: 102423 - HMAC 2015-1 Street Rehabilitation
Project Numbers:
02423 DOE Numbers:
-_--
DOE No.
ProjectiRemoval and replacement on nonfunctional driveway, curb&gutter
Description: land sidewalks; followed by the pulverization and stabilization
of the existing pavement and a 2"HMAC overlay.
Project Manager: Kristian Sugrim _ � City Inspector: Gary Deyon
Contractor: 'JLB Contracting, LLC.
COUNCIL ACTION (If Required):
M&C Log Name:
M&C Number: M&C Date: _
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days:
TPw _ $ 0.00 i 271
r F
F
Total Cost: $ 0.00 Total Requested Days: 271
Approval Status:
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CFW Change Order Approval St-C0App02 Page 3 of 3
Approved: Yes
Comments:
User: Sam Davis
Date: 2018-01-31 12:08 PM
Approved: Yes
Comments:
User: Kristian Sugrim
Date: 2018-01-31 1:02 PM
Approved: Yes
Comments:
User: Lane Zarate
Date: 2018-01-31 9:20 PM
Approved: Yes
Comments:
User: Kim Arnold
Date: 2018-02-13 10:05 AM
Approved: Yes
Comments:
User: Doug Wiersig
Date: 2018-02-13 4:11 PM
Approved: Yes
Comments:
User: Jay Chapa
Date: 2018-02-13 4:28 PM qa��7
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Action Required:
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OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
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Contract Compliance Manager
Re: Change Order No. 1 ($0.00)
Contractor: JLB Contracting, LLC.
Project Name: HMAC 2014-3 Surface Overlay
City Secretary No.: 45640
Project No.: CO2258
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
Project Manager
Title
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