HomeMy WebLinkAboutContract 43493-CO1 (3). c�P� .Z o � a
TPW
Change Order # �1 Date 3/1 612 0 1 3
City Inspector Ali Motamed (817) 944-1174
90
$0.00
15.38
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT
MAX ALLOWABLE CONTRACTAMOUNT (ORIGINAL CONTRACT COST + 25%)
Totals Contract Time
(CD
$898,432.90 120
$898,432.90 120
$52,815.38 40
$951,248.28 160
$0.00
$52,815.38
5.88%
$1,123,041.13
JUSTIFICATION (REASONS) FOR CHANGE OP.DEl2
This change order is submittetl to request quantity increases for two separate line items to facilitate the construction of 2 atlditional streets that
were added to this contract. 1) Blackmore Ave. (Horne St. - Bryant Irvin Rd.) Pulverization. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.)
Pulverization. We further request that 40 Calentlar Days (CD) be added to this contract for the following reasons: 1) Blackmore Ave. (Horne St.
Bryant 4svin Rd.)15 CDs for construction. 2} Littlepage St: {Bl.a�ckmore Ave. - Humbert Ave.) 5 CDs for construction. 3) Wellington Rd. (Camp
Bowie Blvtl. - Hanover Rd.) 6 CDs for a leaking wate�����f�'��`4) Garza Ave. (Marks PI. - Southwest Blvd.) 8 CDs for a leaking water
main valve repair. 5) Kermit Ave. (Marks PI. - Sout � y�he relocation of a shallow water service. 6) Reitly St. (Desert Ridge
Dr. - Marks PI.) 3 CDs for the relocation of 2 sha � serv' s. ��ayo�4 -
-= ---_�- - -_ --�-_ -- �
' � e� .�j �
FORT �ORT'H City of Fort Worth ����, ��C����� r
Chan e Order Re uest ��'��'����' �� \
`��r J q �9I��6��T ��o e —��
Project Name HMAC Surface Overlay (2012-13) At Various Locations City Sec # 43493
Client Project #(s) City Project No: 01921 DOE: 6851
Project Description
HMAC Surface Overlay At Various Locations Throughout The City (Street Maintenance)
Contractor JLB Contracting, LLC
City Project Mgr. Kristian Sugrim (817) 392-8902
Dept.
Original Contract Amount
Extras to Date
Credits to Date
Pending Change Ortlers (in M&C Process)
Contract Cost to Date
Amount of Proposed Change Order
Revised Contract Amount
Original Funds Available for Change Orders
Remaining Funds Available for this CO
Atltlitional Funding (if necessary)
�� �.
Y.
� ;
.�'
�'o..� F �FFI�IAd REC�Fd�
o° "�'"F �ITif SEClSIE�'Ala�
�,r� �To �kl��Vf�9f, °�'�?
c'�' '---------=--- �
It is understootl antl agreed that the acceptance of this Change Ortler 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.
�
m
c�
m
�
m
0
-�v
�
�
�
�
�
Contractor's Corr
JLB Contractinq, LLC
Name I Contractor
� ��
�
Date
./ ,
Date
,i c ;�5
M&C Number
I1
Council Action
/'r
fic�v`�'��:-�,� ��l
Direc�r, Contr��tinq De
' � �
Assista City Manager
� »�.�:.e.� �1`-
(if required)
�;� �� M&C Date Approved Q
Daie
13 �
Date �
�
Date �
'l���/�3
n4�
. `�A
Y ✓ .
i M"
�.� • -Y .. . .�• ,
,�' i
<T
C��`��r' . �, c'� r ,`�;
' .�� FORT wORTH City of Fort Worth
—�'�'�� Change Order Request � "����' �� ,�� ���, � ' � �,�
Project Name HMAC Surface Overlay (2012-13) At Various Locations City Sec # 43493
Client Project #(s) City Project No: 01921 DOE: 6851
Project Description
HMAC Surface Overlay At Various Locations Throughout The City (Street Maintenance)
Contractor JLB Contracting, LLC
City Project Mgr. Kristian Sugrim (817) 392-8902
Dept.
Original Contract Amount
Extras to Date
Cretlits to Date
Pending Change Orders (in M&C Process)
Contraet Cost te Date
TPW
Change Order # � Date 3/16/2013
City Inspector Ali Motamed (817) 944-1174
Totals I Contract Time
.�
$
120
120
40
Revised Contract Amount $951,248.28 $951,248.28 160
Original Funtls Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding (if necessary) $52,815.38 $52,815.38
CHANGE ORDERS to DATE (INCLUDlNG TH1S ONE) AS % OF ORIGINAL CONTRACT 5.88%
MAXALLOWABLECONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $1,123,041.13
JUSTIFICATION (REASONS) FOR CHANGE ORDER
This change order is submitted to request quantity increases for two separate line items to facilitate the construction of 2 additional streets that
were added to this contract. 1) Blackmore Ave. (Horne St. - Bryant Irvin Rtl.) Pulverization. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.)
Pulverization. We further request that 40 Calendar Days (CD) be adtletl to this contract for the following reasons: 1) Blackmore Ave. (Horne St.
Bryant Irvin Rd.) 15 CDs for construction. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.) 5 CDs for construction. 3) Wellington Rtl. (Camp
Bowie Blvd. - Hanover Rd.) 6 CDs for a leaking water main valve repair. 4) Garza Ave. (Marks PI. - Southwest Blvd.) 8 CDs for a leaking water
main valve repair. 5) Kermit Ave. (Marks PI. - Southwest Blvd.) 3 CDs for the relocation of a shallow water service. 6) Reidy St. (Desert Ritlge
Dr. - Marks PI.) 3 CDs for the relocation of 2 shallow water services.
� Y� ��� , ,,-
;��� ''
� � ,��.�..
; �,
It is untlerstootl and agreed that the acceptance of this Change Order by the contractor constitutes an accord antl 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 Company Name Contractor (Name) Contract Signature Dat�
JLB Contractinq, LLC a , � � � ; �'
, . ��, ,,
Assistant Director (Deptj
Assistant City Attorney,
� ,�
M&C Number r,'l t
„/,, � .,;., ,_ . > ;:'
Date Director, Contracting Department Dept
, � t
� �
Date Assistant Cit Manager 1:'
, � ,
� � i � � � � . . , .
Council Action (if requiretl)
� � M&C Date Approved �
� `' ! � '��' � �r� -; r
. , �,
Date
�'� '
Date
Date
J.<'j
�,
�
' `i
, r�. i
; �� �
�.�.
I )`� ��
+ c'�.�: ' ���r' 1.. � �' �
.�,; . . . �;
. ����y,�
't .� 'FORT�ORTH City of Fort Worth
'�''°� Change Order Request •
Project Name HMAC Surface Overlay (2012-13) At Various Locations City Sec # 43493
Client Project #(s) City Project No: 01921 DOE: 6851 �
Project Description
HMAC Surface Overlay At Various Locations Throughout The City (Street Maintenance)
Contractor JLB Contracting, LLC Change Order #�1 Date 3/16/2013
City Project Mgr. Kristian Sugrim (817) 392-8902 City Inspector Ali Motamed (817) 944-1174
Dept.
Original Contract Amount
Extras to Date
Credits to Date
Pending Change Orders (in M&C Process)
Contract Cost to Date
Amount of Proposed Chanae Order
TPW
.�
Contract Time
120
40
Revised Contract Amount $951,248.28 $951,248.28 160
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding (if necessary) $52,815.38 $52,815.38
CHANGE ORDERS to DATE (INCLUDING TH1S ONE) AS % OF ORIGINAL CONTRACT 5.88%
MAXALLOWABLECONTRACTAMOUNT (ORIGINAL CONTRACT COST+ 25%) $1,123,041.13
JUSTIFICATION (REASONS) FOR CHANGE ORDER
This change order is submittetl to request quantity increases for two separate line items to facilitate the construction of 2 additional streets that
were addetl to this contract. 1) Blackmore Ave. (Horne St. - Bryant Irvin Rd.) Pulverization. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.)
Pulverization. We further request that 40 Calentlar Days (CD) be atltled to this contract for the following reasons: 1) Blackmore Ave. (Horne St.
Bryant Irvin Rtl.) 15 CDs for construction. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.) 5 CDs for construction. 3) Wellington Rd. (Camp
Bowie Blvtl. - Hanover Rtl.) 6 CDs for a leaking water main valve repair. 4) Garza Ave. (Marks PI. - Southwest Blvd.) 8 CDs for a leaking water
main valve repair. 5) Kermit Ave. {Marks PI. - Southwest Blvd.) 3 CDs for the relocation of a shallow waker service. 6) Reidy St. {Desert Ritlge
Dr. - Marks PI.) 3 CDs for the relocation of 2 shallow water services.
�
It is untlerstootl and agreetl that the acceptance of this Change Ortler by the contractor constitutes an accord and satisfaction antl represents payment
in full (both time and money) for all costs arising out of, or incidental to, the above Change Ortler.
Contractor's Company Name Contractor (Name) �Contract Signature � Date
JLB Contracting, LLC , . , s . � , .'' ; , . :
Assistant Director
Assistant City Attorney ,
� '. � f ,,
M&C Number
�Date Project M
�, ,
Date Director, �
,,
Totals
$898,432.90
�er Date
„ ,f
t (Dept) Date
�', ' � Date
,lrr ��
m Man
Date Assistant City Manager
`i, �! .,
, r , . . � � , . .
Council Action (if reqi
�';'-� , , � �
M&C Date Approvetl �
1y' '. 1
l��
�
i
•J
{ �
, � LU `
�� ,.
,'' .�
4�
.� �,.o
. �., - p.
� .�
FORT WORTH Citv of Fort Wort�
�"`� Change Order Request
� .�c...r.''T'`r . _� -
Project Name� HMAC Surface Overlay (2012-13) At Various Locations � City Sec #� 43493 j
CliPnt Proiect #(s) Citv Proiect No: 01921 DOE: 6851
Project Descriptionl HMAC Surface Overlay At Various Locations Throughout The City (Street Maintenance) �
Contractor� JLB Contracting, LLC � Change Order# �1� Date 3/16/2013
City Project Mgr. Kristian Sugrim (817) 392-8902 City Inspector Ali Motametl (817) 944-117� �
? �ept.
TPW
Totals
�;,ntract Time
Original Contract Amount
Extras to Date
Credits to Date
Pentling Change Orders (in M&C Process)
Contract Cost to Date
Amount of Pr000sed Chanae Order
E,:•:
Original Funds Available for Change Orders
Remaining Funds Available for this CO
Additional Funding (if necessary)
$0.00
815.38
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT
MAXALLOWABLE CONTRACTAMOUNT (ORIGINAL CONTRACT COST+ 25%J
JU�TI�ICATIOid iP�EASONS{ FOR Cr"iAPdC-�� O�C��
120
IF' �
,�
.1
$0.00
� $52,815.38 �
5.88%
$1,123,041.13
This change ortler is submitted to request quantity increases for two separate line items to facilitate the construction of 2 additional streets that
were atlded to this contract. 1) Blackmore Ave. (Horne St. - Bryant Irvin Rd.) Pulverization. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.)
Pulverization. We further request that 40 Calentlar Days (CD) be atlded to this contract for the following reasons: 1) Blackmore Ave. (Horne St.
Bryant Irvin Rd.) 15 CDs for construction. 2) Littlepage St. (Blackmore Ave. - Humbert Ave.) 5 CDs for construction. 3) Wellington Rtl. (Camp
Bowie Bivd. - Hanover Rd.) 6 CDs for a leaking water main valve repair. 4) Garza Ave. (iviarks PI. - Southwest Blvtl.) 8 Cus for a ieaking water
main valve repair. 5) Kermit Ave. (Marks PI. - Southwest Blvd.) 3 CDs for the relocation of a shallow water service. 6) Reidy St. (Desert Ridge
Dr. - Marks PI.) 3 CDs for the relocation of 2 shallow water services.
It is understood antl agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represenis payment
in full (both time antl money) for all costs arising out of, or incidental to, the above Change Ortler.
Contractor's Company Name Contractor Name Contract Signature Date
JLB Contracting, LLC
Inspector/Inspection Supervisor Date Project ManagerlProgram Manager Date
Assistant Director (Dept Date Director, Contracting Department (Dept) Date
Assistant City Attorne Date Assistant City Manager Date
Council Action if requiretl
M&C Number M&C Date Approved �
N
i
=o
�C =
o�
��
a
��
o�
��
"- O
�
� �
V
�
�
U
x
r
a
�
H
CG
�
�
M
�
d'
M
�
�
U
N
�
.�,'
U
�
w
�
�i.i
O
�
�
�
.s
U
O
J
�
�
O
.`
�
a
N
� N
d �
� O
0
N O
� Z
� U
C/) �
O
Q a`
� �
2 U
a> �
� v
z •°'
0
N d"
�O �
a -
U
M �
� �
N �
� �'
'�t
M �
ti
�
�
N
ia
�
a
a>
� �
m
0
�
� Q
w
-n
O
� o
� U
C N
N d
� �
U 5
�
U
N
�
�
N
�
M
0
�
c
o � rn
.Q � �
.'�"-' U
� O �
� � �
U �,
a�
'o U
d
_ �
:
• �
�
�
s �
•
�
►
.�
. ►
■ .
.
.
.
•�
i
•
• .
�
�
�
�
� �.
�
� �
�
►
�
z
0
0
�
a
N
4-
O
N
N
UA
f0
d
N
C
O
a=+
'�
"L3
Q
i
N
�
i
�
N
aD
C
f0
L
V
N
i
,� ,o
��
o�
�o
��
� d
LL. �
4- O
Q
� �
CU �
�
�
V
x
i�
�
�
i�
CL
Li
M
�
�
d'
�
U
�
T
U
�
�
�
W
�
�
�
c
0
U
J
N
�
O
.�
�
Q
M .�
O �
N �
� �'
� �
M O�
�
a>
m
0
v
N
� �
N
O
�
�k Q
�
N
b
� �
N �
� U
C N
(6 Q
� �
U S
�
U
N
O
�
�
N
�
M
r v
N �
O �
� Q
T T
c° N �—�° U
� O) N J
� � � J
N O N C �
v Z v '�
� � iA c �
N
�O
U � U �,�j .c�_a
2 U 2 m Y
� �# c
� �
Z � •c
� Uv�
N a U�
'o c �
d � U
U �
'o
a`
� .
o �
U �
(`
C �
O
U �
d
�
U
�
�
i
•
�
•I
�
.
-
.
,
:
•
i
•
•
.
�
.
�
z
g
�
w
J
W
0
N
4-
�
N
N
�
cu
a
�
c
0
:�
v
a�
0
L
�
�
L
0
�
�
�
�
�
U
M/WBE Breakdown for this Change Order
MWBE Sub ' Type: of Service Amount for this CO `
Total I ' $0.00 `
��
i
�
�
M&C Review
CITY COUNCIL AGENDA
COUNCIL ACTION: Approved on 7/17/2012
DATE: 7/17/2012 REFERENCE NO.: **C-25724 LOG NAME:
Page 1 of 2
il��� �al site of thc �-�tV ot fort N.�ui th, 1 exa�.
FORT i�'UKTN
�-
20HMAC SURFACE
OVERLAY 2012-13
CODE: C TYPE: CONSENT PUBLIC NO
HEARING:
;� SUBJECT: Authorize Execution of a Contract with JLB Contracting, LLC, in the Amount of
$898,432.90 for Hot Mix Asphaltic Concrete Surface Overlay 2012-13 at Various Locations
, *•
(COUNCIL DISTRICT 3)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of a contract with JLB Contracting,
LLC, in the amount of $898,432.90 for 120 calendar days for Hot Mix Asphaltic Concrete Surface
Overlay 2012-13 at various locations that are listed on the attachments provided.
DISCUSSION:
This project is a part of the Contract Major Mainte�ance Program which provides for the �ehabilitation
of deteriorated asphalt streets. Various pavement repair techniques are utilized depending upon the
level of pavement deterioration. This Contract will provide for asphalt overlay of 18 street segments.
F Funding for this contract is included in the Contract Street Maintenance Fund.
�
�
m
�
0
�
The project was advertised for bid in the Fort Worth Star-Telegram on April 19, 2012 and Aprit 26,
2012. On May 17, 2012, the following bids were received:
Bidder
JLB Contracting, LLC
Peachtree Construction,
Ltd
Amount
$898,432.90
$905,799.40
The City reserves the right to increase or decrease quantities of individual pay items within the
contract provided that the total contract amount remains within plus or minus 25 percent of the
contract award.
JLB Contracting, LLC, is in compliance with the City's M/WBE Ordinance by committing to 17 percent
M/VVBE participation. The City's goal on this project is 16 percent.
These projects are located in COUNCIL DISTRICT 3.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds are available in the current capital
budget, as appropriated, of the Contract Street Maintenance Fund.
-� http://apps.cfwnet.org/council�acket/mc_review.asp?ID=17055&councildate=7/17/2012 7/20/2012
M&C Review
TO Fund/AccountlCenters
�"
�p
�. Submitted for Citv Manas�er's Office bv:
�
Qri�tinating Department Head:
�
,i Additional Information Contact:
�" ATTACHMENTS
20HMAC 2012-13 MAP PAGE 1.pdf
20HMAC 2012-13 MAP PAGE 2.pdf
;�
, �
'�
���
I�
- �-
�"
�
�
i
�
�
�
'�� . . _ _ . _ _ . _ _ . . . _ .
�
�
FROM FundlAccountJCenters
C293 541200 203620192183 $898,432.90
Fernando Costa (6122)
Douglas W. Wiersig (7801)
Kristian Sugrim (8902)
I �. http://apps.cfwnet.org/council�ackedmc_review.asp?ID=17055&councildate=7/17/2012
Page 2 of 2
�
F
_ __ __ . _ . _ �
1
7/20/2012
Page 1 of 1
FORTWORTH
V
E
N
D
O
R
Vendor Number: 0000016042
JLB CONTRACTING LLC
POBOX24131
ACH ONLY
FORT WORTH, TX 76124-1131
CITY OF FORT WORTH
Purchase Order
INVOICES: Direct invoices in DUPLICATE to the address shown.
STANDARD PURCHASING TERMS AND CONDITIONS set forth in the
City of Fort Worth's Bid or Quotation, are incorporated herein by
reference and become a part of this order.
P.O. DATE: 8/17I2012
Purchase Order Number
PO-12-00073283
SHOW THIS NUMBER ON ALL
PACKAGES, INVOICES AND
SHIPPING PAPERS.
TRANSPORTATION & PUBLIC WOR14S
S Administretion
H 1000 Throckmorton Street
� FORT WORTH, TX 76102
P
OPhone: (817) 392-1111
MAIL INVOICE IN DUPLICATE TO:
B TRANSPORTATION & PUBLIC WORKS
� Administration
L 1000 Throckmorton Street
L FORT WORTH, TX 76102
T
0 Phone: (817) 392-1111
Account Code: C293-541200-203620192183 Payment Terms:
Shipping Terms:
Bid No.: Delivery Calendar Day(s) A.R.O.: 0
Item Class-Item Requisition Quantity Unit Unit Price Total
#
Class-Item 913-50
1 HMAC 2012-13 1 EA $898,432.90 $898,432.90
C293-541200-203620192183 CS43493
M&C: C-25724 Date:071712
LN/FY/Account Code Dollar Amount
1/13/C293-541200-203620192183 $898,432.90
TOTAL: $sss,432.90
APPROVED:
Rev.20091027 By: Karen Striker
Phone#: (817) 392-6265
BUYER
. • ' �
a m o
a � �
o °'. �
7 �. �
fU � �
cn
� ��
� � �
a Q �
� � �
� D �
-fi � D
� _. <
c� v v.
� � =
� � -"
N o 0
v
� � Q
� � �
� �.
� �
c� n
c� �
O �
� �
a c�
c� c�
�' O
Q
cn
�
���
�
tv
00
�
� � �
W
�
...
b9 ffl E�
�
N
�
�
�
i �
W
W
..i
ffl ff� b9
i � i
!ii b9 Efl
� i i
� D C�
m 3 0
m � v
� � rt
o ° D
� o °
� � c
� o �.
D � o
3 Q- p
� n v
� � m
r. �
cQ
m
Q
c�
�
���
ai cn t00o
-� iv o0
N 00 ,p
A j W
w c� iv
N W tD
00 00 O
{� 1A EA
c0 W
� N O�D
� � W
�
OD Cli N
N W c0
00 00 O
ffl ffl
� i
f!� ffl
i �
c�'
5�
�
C�
0
m
�
�D � n�
a �
'"� Ul .n-�-
N '-' D
° � �
p 0 0
� �
m ��°. �
���
w
co
�
�P
W
� � N
tp
O
ffl 69 {�
W
�
W
�A
W
� �
N
�
O
tfl {fl
�
ffl E�
� i
�
O
D
r
I�
-0
�
I�
(D
�
I�
N
�
(D
�
—I D � C� C� o0 00 �
an� 0���� �
� � m �, � � -� �-
� � Z '� �' (D (D C�
0� o z� Q a—I
�D o � z o o D
n o � �
� �
� ��m
7 � S
cQ �
� � ..
O
Q.
m
z
0
C�
�
�
�
�
�
0
�
�
�
D
v
C)
�
�
�
�
�
.
�
rn
c�
�
�
c
�
�
�
�
�
r<� ,•,vt�H,•t, . City of l=ot`t Wot`th
AGCEPTANCE OF PREVIOUS Ml1tUBE CaMM1TNIENT FQRM
{fpr use with CHANGE pRpEFiS or AMENDMENiS greater than $50,000j
3�\ ��+��£t� Y+rL��� Ff3� 9ir 9rG�f .� �.�T.u;S 5t A� i' � �(,: r`� �,y E ' y `� �.( tl rr'.o,F� ar �� ice J. ,� s,.y� :�
t �;S'�! ��y('i�l i��k��t�{`_}4 tSt'���.. �'✓!r3 y FK1s ��%� Gxr �� Q ii� ��y�. �. �i�� �r ���1- {I��f rF'�+�'�t ��1� F} ft' } i?�w �,�a.`�.:
.�i� cf r�r.. �:; c�.t � T.�i 4 4 �{kl h. �r ��;f ��i t V}.�7� �^r., x.�,i"' ,�. � t� ..r �,t 7i ��s _ �5�.��54 � t 1� I t='�"
� �^11�.1. J1{ S � � i.5� �t �` �2 � C L � � �yA��}a,,9.N5F1�5tyiaF�`r r�;#`e���'�fJ�rl, x�.Er� � t4r�T�4.4�rfp.��'�'t",,'. �}{,,�'tl��*t� ;t�{V �\�}+�:{��f`�k4�iY ..ri �9 ��,� y;�
� ov} �:iTd �.1{i1� ` ��f� � n � �,g}� ti l� �{f �l � %i'��w�i411 � ���/ I�r�,u�y��t i,'lt��y �i �i6 /�} jii.fr�� F � �i("��d ��r� `�'`�� � �' ^ s�
.��s '�t�at�}.2� s f� � ts� ��'� ��rrS � i�( .t�l § 4��! +. N�A!.^3Yi� k .. 2t, i •t 1��. .'1 ..r,..t��l'd�xa!ls.:�'4 � �iEA1P..{ ���,`I 41��Ycr �.i���'�.
�i�'�.re;na�C�plQ'' is�:}�'jf �' �A� i i4'•�`i ���1 at R 1 � �r d fa i � k � t�' � f 3tyd� �"'�
�i ° t��i�tt��t ��/a�� a .�! ����4u v`t}� s�;.i�5rhaatj`,�'�iY,�'�e +ttiCa .1"•yt, ..ti ' s��r. +n.•.:5Yjib'+.'}- jti�`tr�'n.�y"��.7�.0 •y
r�ti(�E�.�'il:{�j �((�F3%4 a� 1 t �"� � r k �i� ``'��t t�s� ''(,b e � la# r i F'b5 r§ i L[ , ��} ����lntll H�.a� l
�.:::.1:2�r�..�iM.,.;r7�tr1'i.nua�7i.4�..�'r�'lj.'.t�i�.v.t?��f.��;.�tf...�.���jl.3'}jh!;1�1k��1.i�lr}��°�:tNiY�ii��yi�'�1���"�it�tl��ylx���"�L�1.,.4e��.f�iiii l3 4 ��r5'�:�..
�.... . . . . ;r< <��=h�?�{s�a�.+ M1n19�i�r.;,....,,� :�.
/ .....__.. .................. ...... �. ....�. `s�c"�r ar>� ....��...........,�. .._......__ ..... ...
MMAC:Surface°Overf�' 2017-1:9 ... . ..:� � �i n �y
. ��1�� ��....,., .:k_ ���,5,._��r�:]...i.'t7�€��.]!,u:.'nY .i�. Y .tr:ra_:KP,:.�:.i.r,,s:,.�
JL-B �nntraoting, LLC.
�w898,432,�Jq
�52�8.15:�8.
.,.�.....M--.,�,--
�J51.2d8.2i�
Language ta be inserted in the M&C for this Con#ract
3/1
c 16
: 1'T
JLB Contraciing, LLC. agrees to maintain its initial M/WBE commltment of 17% that it made on
fhe ariginal cantract and extend and maintain that same M/WR� commitment of 17% to this first
change order. Therefore JLB Contracting, LLC. remains in compliance with the City's M/WB�
Ordinance and aftests to its commitmertt by its signature on the Acceptance af Prevlous MIWBE
Commitment form executed by an aufharized represenfative of its company.
Ta be Campletec! by the Representa#ive of the Cantractor
��l �M �.��'9�" t.f _ r, a;"5 t d`J d.�... T .�''�„ �.... ��,�o'� 3
Prfnted Signature Tftle Author(zed Signature/Date
JLB Contract(ng, LLC.
CompanyName Contact Name (ff different}
1Qa� �01C �¢ ( 3 t "�'�"!' 1,r��.S�.� r��- � C.w�aT�► c 7`i.a► . t ex�
Address �-mail address
�r.�a�t�r,.�J'j'K "?'G r �.'�- �,�, 2wr ZZ�� ��� �4r 3�°�-d
City/StatelZlp Phone number Fax Number
_ � a� . `J"�� as of �',G �� 01 't.
M/W8� % Paid to Date Date
e1a+
�
I'+.!
�ry
.�
h�