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Home My WebLink AboutContract 41735-CO1FORT WORTH .. ~ City of Fort Worth Change Order Request CITY SECRETARY CONTRACT NO . ~/ J 7 3-S--( 0 I Project Name! HMAC Surface Overlay At Various Locations (2011-04) I City Sec# 41735 Cl ient Project#(s)! C293-541200-202620168683 City Project No.: 01686 DOE : 6623 Project Description HMAC Surface Overlay Throughout the City Contractor! JLB Contracting , LLC City Project Mgr.l Kristian Sugrim Change Order# Date 8/4/2012 (817) 392-8902 City Inspector Ali Motamed (817) 944-1174 Enter Department(s) to the Right and TPW Contract Day Type Original Contract Amount $1 ,212 ,993 .90 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $1 ,212 ,993 .90 I Go to ADD & DEL Tabs to Enter CO Backup $0.00 Rev ised Contract Amount $1 ,212 ,993 .90 Original Funds Ava ilable for Change Orders Remaining Funds Available for this CO $0.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) Totals $1,212 ,993 .90 $1 ,212 ,993 .90 $1 ,212 ,993 .90 $0 .00 0.00% $1 ,516 ,242 .38 JUSTIFICATION (REASONS) FOR CHANGE ORDER OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Time (CD) 120 120 149 269 1 It is unde rstood 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 inc idental to , the above Change Order. Contractor's Com an Contractor Name 'Date ~~~~::::!:::::_~~~~"{::D_~~~~~~~~.--~~8~7'~~~~==--l ~t ~~~~-----h,.~~~~~~A--h~~~ M&C Number ~~( ~pli I .xfoRTWORTH .. ·~ . ( City of Fort Worth Change Order Request Project Name! HMAC Surface Overlay At Various Locations (2011-04) Client Project #(s)! C293-541200-202620168683 City Project No .: 01686 Project Description HMAC Surface Overlay Throughout the City Change Order # City Sec # 41735 DOE : 6623 Date 8/4/2012 Contractor! JLB Contracting , LLC City Project Mgr.! Kristian Sugrim (817) 392-8902 City Inspector Ali Motamed (817) 944-1174 Ent~r Department(s) to the Right and T pi/,/ -1, I'/ r Contract Day Type L < Original Contract Amount $1 ,212 ,993 .90 Extras to Date -eredits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $1 ,212 ,993 .90 I Go to ADD & DEL Tabs to Enter CO Backup $0.00 Revised Contract Amount $1,212 ,993.90 Original -funds-Available for Change Orders Remaining Funds Available for this CO $0.00 Additional 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 I -!T otals Contract Time (CD) $1 ,212 ,993 .90 120 ( $1,212 ,993 .90 120 149 $1 ,212 ,993.90 269 $0.00 0.00% $1 ,516,242.38 This change order is submitted to request that an additional 149 calendar days (CD) be added to this contract to compensate for the inclusion of the following five (5) streets : Cortez Dr . 27 CD, (Mojave Tri. -Laredo Dr.), El Retiro Rd . 26 CD , (E . Dead End -Cortez Dr.), Little Fox Ln. 25 CD, (Stoney Bridge Rd . -Peppertree Ln .), Phoenix Dr . 23 CD , (El Ret iro Rd. -Arbor Ave .) and Woodstream Tri. 48 CD , (Woodmont Tri. - Canyon Cir.). No additional funding is required/requested due to procedural changes on other streets originally assigned to this contract. 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 Com an Name Contractor Name Date \~ ()._ Date 6/Jb// L \v t ~~~7"il'r-F"7--------t-u~~"f,,,=::;~""."--'-L-...C....~r--+-rr-----+-=--i'::~=-=--I~~ M&C Number 11.0( ~~~ ( . . FORT WORTH .. ~ ... City of Fort Worth Change Order Request Project Name! HMAC Surface Overlay At Various Locations (2011-04) Client Project#(s)! C293-541200-202620168683 City Project No.: 01686 Project Description HMAC Surface Overlay Throughout the City Change Order# City Sec # 41735 DOE: 6623 Date 8/4/2012 Contractor! JLB Contracting , LLC City Project Mgr .! Kristian Sugrim (817) 392-8902 City Inspector Ali Motamed (817) 944-1174 Enter Department(s) to the Right and TPW ' · -~ Contract Day Type Original Contract Amount $1 ,212 ,993.90 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $1 ,212 ,993 .90 I Goio ADD-& DEL Tabs to Enter CO Backup $0.00 Revised Contract Amount $1 ,212 ,993 .90 Original Funds Available for Change Orders Remaining Funds Available for this CO $0 .00 Additional 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 -Totals Contract Time (CD) $1 ,212 ,993 .90 120 $1 ,212 ,993 .90 120 149 $1 ,212 ,993.90 269 $0 .00 0.00% $1,516 ,242 .38 This change order is submitted to request that an additional 149 calendar days (CD) be added to this contract to compensate for the inclusion of the following five (5) streets : Cortez Dr . 27 CD , (Mojave Tri. -Laredo Dr .), El Retiro Rd . 26 CD , (E. Dead End -Cortez Dr .), Little Fox Ln. 25 CD, (Stoney Bridge Rd . -Peppertree Ln .), Phoenix Dr. 23 CD , (El Retiro Rd . -Arbor Ave .) and Woodstream Tri. 48 CD , (Woodmont Tri. - Canyon Cir.). No additional funding is required/requested due to procedural changes on other streets originally ass igned to this contract. I 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 Com an Name Contractor Name Date Date -; 12,. ) Date / 2, 11 M&C Number - , " FORTWORTH .. / - City of Fort Worth C hange Order Request ( I/ I Project Name! HMAC Surface Overlay At Various Locat ions (2011-04) City Sec # 41735 Client Project #(s)I C293-541200-202620168683 City Project No .: 0168 6 Project Description HMAC Surface Ove rlay Throughout the City Contractor! JLB Contracting , LLC Change Order # DOE : 6623 Date 8/4/2012 Cit y Project Mgr. i Kri st ian Sugrim (817) 392-8902 City Inspector Ali Motamed (817) 944-1174 Enter Department(s) to the Right and TPW Contract Day Type Original Contract Amount $1,212 ,993 .90 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $1 ,212 ,993 .90 I Go to ADD & DEL Tabs to Enter CO Backup $0 .00 Revised Contract Amount $1 ,212 ,993 .90 Original Funds Ava ilable for Change Orders Remaining Funds Available for this CO $0 .00 Additiona l 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 Totals Contract Time (CD) $1,212 ,993 .90 120 $1 ,212 ,993.90 120 149 $1 ,212 ,993 .90 269 $0 .00 0.00% $1 ,516 ,242 .38 This change order is submitted to request that an additional 149 calendar days (CD) be added to this contrac t to compensate for the inclusion of the following five (5) streets : Cortez Dr. 27 CD , (Mojave Tri. -Laredo Dr .), El Retiro Rd . 26 CD , (E. Dead End -Cortez Dr.), Little Fox Ln . 25 CD , (Stoney Br idge Rd. -Peppertree Ln .), Phoenix Dr. 23 CD , (El Retiro Rd. -Arbor Ave .) and Woodstream Tri. 48 CD , (Woodmont Tr i. - Canyon Cir .). No additional funding is required/requested due to procedural changes on other streets original ly assigned to this contract. It is understood and agreed that the acceptance of this Change Order by the contracto r constitutes an accord and satisfaction and represents payment in fu ll (both time and money) for all costs aris ing out of, or incidental to , the above Change Order . Contractor's Com an Name Contractor Name Contract Si nature Date JLB Contractin , LLC :r Inspector/Inspection Supervisor Date Project ManaQer/ProQram Manaqer Date ,1 ' I ' .. l,lrrJ,.. ..... _ ""'1, I I (7. I Assistant Director (Dept) Date Director, ContractinQ Department (Dept) Date Assistant City Attorney Date Assistant City Manager Date / ·I,,,.. .. :"'! I-• 1, Council Action if requ ired) M&C Number I I M&C Date Approved I I ( I FORT WORTH ---.-- Project Name Client Project# City of Fort Worth Change Order Additions HMAC Surface Overlay At Various Locations (2011-04) C293-541200-202620168683 City Project No .: 01686 Project Description HMAC Surface Overlay Throughout the City Contractor JLB Contracting , LLC City Sec# 41735 DOE : 6623 Change Order# Date 8/4/2012 City Project Mgr. ......_K_ris_ti_an_S_u..._gn_·m ____ .... (8_17 ..... )_3_92_-8_9_02 __ __, City Inspector ......_A_li _M_ot_am_ed ___ .... (8_1 ..... 7)_94_4_-1_1_74 __ ADDITIONS IIEM Ut:SL;Klr' IION Utr'I Qty Unit unit cost 1ota1 ---·-11me un1y ••••• .. Change Order Add1t1ons Page 1 of 2 TPW $0 .00 :suo I otal Add1t1ons Change Order Additions Page 2 of 2 FORT WORTH ----.--- Project Name Client Project# City of Fort Worth Change Order Deletions HMAC Surface Overlay At Various Locations (2011-04) C293-541200-202620168683 City Project No .: 01686 Project Description HMAC Surface Overlay Throughout the City Contractor JLB Contracting , LLC City Sec# 41735 DOE : 6623 Change Order# Date 8/4/2012 City Project Mgr . ......_K_ris_ti_an_S_u .... gr_im ____ ..,_(8_17_,_)_3_92_-8_9_02 __ __, City Inspector ,___A_li _M_ot_am_e_d __ _.....(8_1 ..... 7)_9_44_-1_1_7 4 _ __. DELETIONS 11 t:M ----rrl IUN Ul:I"' I l.Jty Unit Unit t.;OSt IOtal ----11me un1y ----- Change Order Deletions Page 1 of 2 TPW $0 .00 suo Iota Deletions Change Order Deletions Page 2 of 2 M/WBE Breakdown for this Change Order MWBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders CO# DATE AMOUNT Total $0.00 PROJECT SUMMARY SHEET (Change Order Attachment) PROJECT NAME: HMAC 2011-4 Surface Overlay BuySpeed No (T/PW): BuySpeed No (Water): City Project No: Contract No : 0.0.E. No : Attachment to Change Order No: Today's Date: Original Contract Amount: Extras to Date: Credits to Date : Contract Amount to Date : P0-11-00065915 N/A 01686 CS41735 6623 1 8/16/12 Amount of Proposed Change Order: Revised Contract Amount: Contingency Funds Avail. for Admin. Change Orders : Remaining Funds Available for Change Orders : Additional Funding (if necessary): Additional time requested: 149 days Original M & C, C-24843, approved 04-05-11 TOTAL $ 1,212,993.90 $ $ $ 1,212,993.90 TIME ONLY $ 1,212,993.90 $ $ $ Prepared By: Christy Ezernack T/PW Construction Services