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Home My WebLink AboutContract 50567-CO1 CITY SECRETARY FORT WORTH. City of Fort Worth cowmCT N0. 505 0-GO 1 Change Order Request Breakdown Project Namel HMAC 2017-5 Street Rehabiliation at Various Locations City Sec# 1 50567 Client Project#(s)l 101265 Contractorl JLB Contracting,LLC PM Kristian Sugrim Inspectorl Martina Salinas Change Order Submittal# Date 10/2612018 Dept. T/PW Contract Time Totals CD Original Contract Amount $1,945,950.00 $1,945,950.00 210 Extras to Date 15 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $1,945,950.00 $1,945,950.00 225 Amount of Proposed Change Order $60,604.10 $60,604.10 21 Revised Contract Amount 2,006,554.10 $2,006,554.10 246 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 Additional Funding(if necessary) $60,604.10 $60,604.10 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 3.11% MAXALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $2,432,437.50 JICA-TION(R�A$6NS)i CR CHANGE ORDER This Change Order submittal will i}i ovidk%for 1 ie.rehabilitation c-an existing Sanitary Se ZrManhole on Overton Pa,k Drive. Also,a procedu.-ai change had to be made,on Overton Park Drive,because of changes in elevation;so additional quantities needed to be added to pulverization/stabilization items,and removed from the milling item. Staff concurs with the Contractor's request for an additional 21 calendar days. F ENUAL RECURV, CITY SECRETARY ET. WORTH,Tx r. City of Fort Worth Change Order Additions Project Name HMAC 2017-5 Street Rehabiliation at Various Locations City Sec# 50567 Client Project# 101265 Contractor JLB Contracting,LLC PM Kristian Sugnm InspectorlF Martina Salinas Change Order Submittal# 0 Date 10/26/2016 AUDI I IUNS y Unit Unitos o a new e w aniary Sewer Manhole 1.UUUUUUUU EA 71= $/,Ibb.Uu Pavement u veriza ion Cement o i ica ion Roadbond --3TTn—e—wT Epoxy Lining for SS Manhole T/PW $76,699.10 Sub Total Additions 76, 10 Change Order Additions Page 1 of 1 FORIT WORTH City of Fort Worth - -VI - Change Order Deletions Project Name HMAC 2017-5 Street Rehabiliation at Various Locations City Sec# 50567 Client Project# 101265 Contractor JLB Contracting,LLC PM Kristian Sugrim Inspector Martina Salinas Change Order Submittal# 0 Date 10126/2018 UtLtl IUNb m n os otal Surtace T/PW $16,095.00 Sub Total Deletions 16,095. Change Order Deletions Page 1 of 1 M/SBE Breakdown for this Change Order M/SBE Sub Type of Service Amount for this CO None Total $0.00 Previous Change Orders Co# DATE AMOUNT Total $0.00 CFW Change Order Approval COAppr-01 Page 1 of 4 Routing Assigned To: Due Date: Assigned By: Due Time: Links 2 fortworthgov/Infrastructure Proiects/101265 - HMAC (2017-5)/Contractor/Change Orders/APC H2O17- 5 101265 COLD& fortworthgov/Infrastructure Proiects/101265 - HMAC (2017-5)/Contractor/Change Orders/co 1 - Duly&mh on overton/Change Order Breakdown - col mh Duly overton aaoroved.xlsm Attachments(0) No Attachments have been added to this form. https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&Proces... 12/13/2018 CFW Change Order Approval COAppr-01 Page 2 of 4 FORT WORTH. city of Fort Worth --.-• .-� Change Order Request Approval (Change Order Breakdown Available in Links) For Change Order Submittal No.: 1 Change Order No.: COAppr-01 Date Started: 2018-11-26 City Sec. No.: 50567 Date Due: 2019-01-15 Project Name: HMAC (2017-5) Project Numbers: 101265 DOE Numbers: Project HMAC 2017-5 Street Rehabilitation; Removal and replacement of Description: broken and non-functional curb and gutters, driveways and sidewalks, followed by the pulverization and stabilization of the existing pavement and a 2" HMAC overlay. Project/Contract Compliance Kristian Sugrim City Inspector: Martina Salinas Manager. Contractor: JLB Contracting, LLC. COUNCIL ACTION (If Required): M&C Log Name: M&C Number: M&C Date: COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW $ 60,604.10 30100-0200431-5740010-101265-0 21 Total Cost: $ 60,604.10 Total Requested Days: 21 Approval Status: https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?SiteId=51500&Proces... 12/13/2018 CFW Change Order Approval COAppr-01 Page 3 of 4 Approved: Yes Comments: User: Sam Davis Date: 2018-11-26 4:26 PM Approved: Yes Comments: User: Kristian Sugrim Date: 2018-11-28 10:20 AM Approved: Yes Comments: User: Sam Davis Date: 2018-11-29 4:28 PM Approved: Yes Comments: User: Kristian Sugrim Date: 2018-11-29 4:43 PM Approved: Yes Comments: User: Lane Zarate Date: 2018-12-03 4:25 PM Approved: Yes Comments: User: Ricardo Matute Date: 2018-12-04 4:25 PM Approved: Yes Comments: User: Signing for TPW Director Role Approvals Date: 2018-12-06 9:19 AM F®RTS' Approved: Yes Comments: / User: Doug Black Date: 2018-12-10 3:28 PM Wald P. Gonzales, s .City Approved: Yes Comments: User: Susan Alanis Date: 2018-12-12 5:29 PM -- �- OFFICIAL RECORD CITY SECRETARY FT. WORTH,TX https://projectpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?Siteld=51500&Proces... 12/13/2018 CFW Change Order Approval COAppr-01 Page 4 of 4 Action Required: https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&Proces... 12/13/2018 r" H City of Fort Worth ACCEPTANCE OF PREVIOUS MBE COMMITMENT FORINT (for use with CHANGE ORDERS or AMENDMENTS greater than$50,000) To be Completed by City Project Manager Change Order(for Construction Contract) Project Name: City Project Number HMAC 2017-5 Street Rehabilitation 101265 City Project Manager Contractor: Kristian Sugrim JLB Contracting, LLC City's MBE Project Goal: 11 Original Amount of Contract: $1,945,950.00 Accepted MBE Commitment: 11 % Total of Previous Change Orders: $0.00 Date of Last MBE Report: Amount for this Change Order: $60,604.10 Change Order#: 1 Revised Amount of Contract: $2,006,554.10 Date: 11/2112018. Language to be inserted in the M&C for this Contract JLB Contracting, LLC agrees to maintain its initial MBE commitment of 11% that it made on the original contract and extend and maintain that same MBE commitment of 11%to this first change order. Therefore JLB Contracting, LLC remains in compliance with the City's BIDE Ordinance and attests to its commitment by its signature on the Acceptance of Previous MBE Commitment'form executed by an authorized representative of its company. To be Completed by the Representative of the Contractor Sam Davis President �� - 11/21/18 Printed Signature 'Title Authorized Signature/Date JLB Contracting, LLC Company Name Contact Name(if different) PO Box 24131 sdavis@jlbcontracting.com Address E-mail address Fort Worth, Texas 76124 817-261-2991 817-261-3044 City/State/Zip Phone number Fax Number 55 % (paid to MBE/work completed) as of 10/15/18 MBE%Paid to Date Date City Project Manager has reviewed the work associate wit this Change Order, considers it the same or similar to work in the original Contract, and recommends that the Contractor havq the option to retain a con rrm its existing MBE commitment. Kristian Sugrim %`. 11/21/2018 City Project Manager City Project Man ger Signature Date Attach Comp/eComp/ete Change Order Documentation CompletedTo be Compliance M/WBE Compliance Staff ID# MBE Current% Level via Last Report Recd M/WBE Signature Date Contract Compliance Manager Re: Change Order No. 1 ($60604.10) Contractor: JLB Contracting, LLC Project Name: HMAC 2017-5 Street Rehabilitation City Secretary No.: 50567 Project No.: 101265 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. ame of Employee Promect Manager Title j E ECURCETA Y H, T