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FILE
PROJECT MANAGER
CONTRACTOR
CITY OF FORT WORTH
CHANGE ORDER REQUEST
1` SEGREiARY�-I-�
OPV�`RAC~ NO, .
CHANGE ORDER NO,
DATE
D.O.E. NO
PROJECT NO,
1
0816108
N/A
C293-541200-208620074783
PROJECT DESCRIPTION Street Pavement repair at various Locations
CITY SECRETARY CONTRACT NO,
34769
ORIGINAL CONTRACT AMOUNT...................................................................................................................................................................$ 733,814.00
EXTRASTO DATE.....,,. I., go @go go, to, too *** 0 1 . 1 4 1 1 1 1 1 1 1 1 0 1 1 . q . . . . . . . . . . q , , N , N N 4 0 * 0 , 0 . . . . . . . . 0 . . . . . . . 0 0 0 6 . 6 0 * . . . 1 0 , I , , '9 we* tog vto"Itt too *go'* * . . $ — 0
CREDITSTO DATE, . a * I & I I s 1 0 0 9 p W 9 p V 9 p 0 0 p I I p 0 0 . . . C . . . . . . . . I I I I I I I I I I . 1 141, W W & 1 0 0 '004 0 0 N * . . . . . . I . . . . 0 , 9 00* see 0 0 * 0 0 6 #*, 0 . . . . q . . . . . . . . oplooequo e 0 *19 1 1 1 V p q p 1 9 4 0 q I * I p 9 0 4 0 0 # * 0 0 6916.6 . . . . . $ — 0 —
CONTRACTCOST TO DATE.............................................................................................................................................$ 733,000.00
AMOUNT OF PROPOSED CHANGE ORDER. . 6 0 1 6 q 6 a V 6 . . . . . 4 0 0 0 0 * 0 0 4 # 6 0 1 0 0 9 + 0 0 , , 0 ............... wv"v .... .......................... 11 ....... $ 16,270.00
REVISEDCONTRACT AMOUNT........................................................................:..........................:.................:.......................I..................$ 7495270900
ORIGINAL FUNDS AVAILABLE FOR CHANGE ORDERS....................................................................................................$
REMAINING FUNDS AVAILABLE FOR CHANGE ORDERS, 9 0 0 1 4 9 6 0 p I V * p p V 0 p I p 1 0 1 4 r I a a 1 0 V 0 0 * 4 0 1 0 0 r 0 0 & 4 9 * 0 & * 0 & a 6 4 q * p , q q V 9 0 9 0 V . . . . . . o , o . . . .
ADDITIONAL FUNDING (IF NECESSARY)............................................................................................................................$
)ER PERCENTAGE (INCLUD/NG TNIS CHANGE ORDER) OF THE ORIG. CONTRACT COST
MAX. ALLOWABLE CONTRACT AMOUNT (OR/G. CONTRACT +25%)---------------------------•
IN ACCORDANCE WITH THIS CHANGE ORDER, THE CONTRACTOR SHALL:
Item
Description
uanti Unit Cost
$ 917,267.50
Total
5 Remove Concrete Driveways 1000 SF $ 1.50 $ 1,500.00
6 Install Concrete Driveways 1000 SF $ 4.92 $ 4,920.00
26 2" Surface Milling 6000 SY $ 1.40 $ 85400.00
27 Pavement Crack Sealing 2,9000 LF $ 0.50 $ 15450400
Net Change $ 16,270.00
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in
full (both time and money) for all costs arising out of, or incidental to, the above Change Order.
CONTRACTOR'S NAME: Advanced Paving
ORIGINAL CONTRACT TIM
A IONAL
APPROVED TINIE TO DATE
APPROVED
CONTRACT TIME TO
DATE
ADDITIONAL TIME FOR THIS CHANGE ORDER
1 ]5 working day
0 working
days
CONTRACTOR J(
DATE
PROJE M GER
DATE
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MANAGER/CONST, SER.
DATE �!
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DntECTO"IANAGING
DEPT
DATE
DHtECTOR/CONTRA
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ASSISTANT CITY a1ANAG
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DATE
7
COUNCIL ACTION ( R
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9 APPROVED 81 DISAPPROVED/
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OTHER
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
DATE 08/6/08
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
CHANGE ORDER JUSTIFICATION RECORD
PROJECT NAME: HMAC Surface Overlay (2007-5)
CHANGE ORDCR: 1 DOF, NO. N/A
INSPECTOR: Gilbert Ybarra5 SRLS TEXAS, LLC
PROJECT NtANAGER: Riad Nusrallah
REASON (S) FOR CHANGE:
PROJECT NO C293-541200-208620074783
PHONE No: 469-877-5820
PHONE NO: $ ] 7.392-2486
1. Additional driveway approaches needed to be replaced due to settling causing inadequate storm water flow.
2. Additional surface milling needed due to high pavement crown.
3. Additional crack sealing needed due to high volume of pavement cracking.
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INSPECTOR PROJECT IVIANAG Al
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NIANA R OF CONST. SERVICE
DIRECTOR tNNIAGING D PT.
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DIR. OF CONTR T119