HomeMy WebLinkAboutContract 50339-CO1 CITY SECRETARY:
CONTRACT NO. �`)U33H On l
FORT WORTH. City of Fort Worth
Change Order Request Breakdown
ProjectNamel W.Lancaster Ave Bridge Rehabilitation(2017-2) City Sec# 1 50339
Client Project#(s)l CPN 100633
ontr Gibson&Associates,Inc PM Tariqul Islam Inspectorl Oscar Aguillon
Change Order Submittal# Date 611312018
CC�SCC� Dept. TIPW Water Sewer Contract Time
Totals CD
Original Contract Amount $695,694.00 $695,694.00 130
Extras to Date
Credits to Date
Pending Change Orders(n M&C Process)
Contract Cost to Date $695,694.00 $695,694.00 130
Amount of Proposed Change Order $27,000.00 $0.00 $27,000.00
Revised Contract Amount $722,694.00 $722,694.00 130
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $27,000.00 $27,000.00
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 3.88%
MAXALLOWABLECONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $869,617.50
i
This Change Order is to add 216 SY of concrete structural repair on bents at various location that was found during construction and not shown on plan.
OFFICIAL RECORD
CITY 31CRETARY
FT.WORTNO YX
City of Fort worth
Change Order Additions
Project Name W.Lancaster Ave Bridge Rehabilitation(2017-2) City Sec# 50339
Client Project# CPN 100633
Contractorl Gibson&Associates,Inc PM= Tadqul Islam Inspectorl OscarAguillon
Change Order Submittal Date 6/13/2018
ADDITIONS
Ty Unit Unit Cost Total
T/PW $27,000.00
Water $0.00
Sewer $0.00
Sub Total Additions $27,0UM
Change Order Additions Page 1 of 1
FORT WORTH City of Fort Worth
v--- Change Order Deletions
Project Name I W.Lancaster Ave Bridge Rehabilitation(2017-2) City Sec# 50339
Client Project# I CPN 100633
Contractor Gibson 8 Associates,Inc PM Tariqul Islam Inspector Oscar Aguillon
Change Order Submittal# Date 6/1 312 01 8
DELETIONS
HEM DESCRIPTION DEP I ty Unit U nit Cost Total
T/PW $0.00
Water $0.00
Sewer $0.00
Sub 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 $0.00
CFW Change Order Approval St-COApp01 Page 1 of 3
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthgov/Infrastructure Proiects/100633 - Bridge Rehabilitation 2017-2/Contractor/Change Orders/Change Order 1
Breakdown CPN 100633.xlsx
Attachments(0)
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CFW Change Order Approval St-COApp01 Page 2 of 3
FORT WORTH® city of Fort Worth
�-�.• Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal No.: St- COSub01
Change Order No.: St-COApp01 Date Started: 2018-06-19
City Sec. No.: 50339 Date Due: 2018-06-29
Project Name: 100633 - Bridge Rehabilitation 2017-2
100633 DOE Numbers:
Project Numbers:
Project Rehabilitaiton of W. Lancaster Ave bridge
Description:
Project Manager: Tariqul Islam City Inspector: Oscar Aguillon
Contractor: Gibson &Associates, Inc
COUNCIL ACTION (If Required):
M&C Log Name:
M&C Number: M&C Date:
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days:
TPW $ 27,000.00 30100 0200431 5740010
100633 002680
Total Cost: $ 27,000.00 Total Requested Days: 0
Approval Status:
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CFW Change Order Approval St-COApp01 Page 3 of 3
Approved: Yes
Comments:
User: Joe Montgomery
Date: 2018-06-19 5:04 PM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2018-06-19 5:09 PM
Approved: Yes
Comments:
User: Riad Nusrallah
Date: 2018-06-22 10:59 AM
Approved: Yes
Comments:
User: Lauren Prieur
Date: 2018-06-22 4:28 PM
Approved: Yes may- FORT
Comments:
User: Doug Wiersig Al l?i
Date: 2018-06-28 12:11 AM `•
r
Approved: Yes Atm by'
Comments: ..' ••
User: Doug Black `��►S
Date: 2018-07-10 7:43 PM
ary J. sc r Secretary
Approved: Yes
Comments:
User: Susan Alanis
Date: 2018-07-12 5:43 PM MQ C:
Action Required:
t
L.RECORDCRETARYRTH,TX
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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.
Tariqul Islam
Title
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX