HomeMy WebLinkAboutContract 52634-CO2�dRT W�RT�� City of Fort Worth
�T Change Order Request CSC No. 52634-0O2
Project Name Trffic Signal Mods and Upgrades at Various Location throughout the City City Sec # 52634
Client Project #(s) 101729
Project Description Traffic Signal Modification and Upgratles contrac for varoios construction projects
Contractor Siemens Mobility, Inc. Change Order # 2 Date 5/24/2021
City Project Mgr. Yang Jin City Inspector Cedric Dorsey
Dept.
Original Contract Amount
Extras to Date
Credits to Date
Pending Change Ortlers (in M&C Process)
Contract Cost to Date
TPW
Contract Time
Totals (CD)
$750,000.00 365
$750,000.00 365
$75Q000.00 365
$0.00
0.00%
$937,500.00
Original Funds Available for Change Ortlers
Remaining Funds Available for this CO
Adtlitional Funding (if necessary)
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT
MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%)
JUSTIFICATION (REASONS) FOR CHANGE ORDER
Atltlitional bitl items that were not inclutletl in the original contract are neetled in ortler to construct proposetl improvements. The atltlitional bid items will not increase the total
contract amount.
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. The Project/Program Manager signing below acknowledges that
he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements.
Contractor's Company Name Contractor (Name) Contract Signature Date
SIEMENS William Tucker, Jr aE�C'-1� %G!Cl�e�,
Transportation and Public Works Date Transportation and Public Works Date
Yang Jin Ya"g��" Rajnish Gupta ���� ���� �
Date Transportation and Public Works Date
Tanya Brooks r"'�" sr�
Transportation and Public Works Date City of Fort Worth Legal Date
William Johnson �" Doug Black �
CMO CSO
✓� ' '
Dana Burghdoff �� � � Mary Kayser ��i�
Date Date
Council Action (if required)
ATTEST:
��'�� �
Mary J. Kayser, City Secretary
M&C Number NIA
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M&C Date Approved NIA
�FFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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.
Yang Jin �
G����
Name of Employee/Signature
Engineering Manager
Title
❑ This form is N/A as No City Funds are associated with this Contract
/
Printed Name Signature
ATTEST:
r��'L'' ��' 0
Mary J. Kayser, City Secretary
�FFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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City of Fort Worth
Change Order Additions
Project Name Trffic Signal Mods and Upgrades at Various Location throughout the City City Sec # 52634
Client Project # 101729
Contractor Siemens Mobility, Inc. PM Yang Jin Inspector Cedric Dorsey
Change Order Submittal #�2 Date 5/24/2021
ADDITIONS
Change Order Additions Page 2 of 4
Foe.__��y City of Fort Worth
Change Order Deletions
Project Name Trff c Si nal Mods and U rades at Various Location throu hout the Cit City Sec # 52634
ClientProject# 101729
Contracror Siemens Mobility, Inc. PM Yang Jin Inspector Cedric Dorsey
Change Order Submittal #�2 Date 5I24I2021
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Change Order Deletions Page 3 of 4
MISBE for this Change Order