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Home My WebLink AboutContract 42079-CO1'i' FORT WORTH .. ~ City of Fort Worth Change Order Request Project Name! HMAC Surface Overlay ( 2011-12) At Various Locations Client Project #(s)j C293-541200-209620173083 City Project No : 01730 Project Description HMAC Surface Overlay Throughout the City (!t!)i=Jy J_ C, F" ~ g~:;~e:'t, ljtil 7q -col I City Sec # 42079 DOE: 6675 Contractor! JLB Contracting , LLC City Project Mgr.! Kristian Sugrim Change Order # Date 5/30/2012 (817) 392-8902 City Inspector Anthony Host (817) 223 -2281 Enter Department(s) to the Right and TPW Totals Contract Time Contract Day Type (CD) Original Contract Amount $918 ,529.50 $918 ,529 .50 120 Extras to Date Credits to Date Pend ing Change Orders (in M&C Process) Contract Cost to Date $918 ,529 .50 $918 ,529 .50 120 !Amount of Proposed Change Order $0.00 147 Revised Contract Amount $918 ,529 .50 $918 ,529 .50 267 Original Funds Available for Change Orders $0 .00 Rema ining Funds Ava ilable for th is CO $0.00 Additiona l Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS% OF ORIGINAL CONTRACT 0.00% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $1 ,148 ,161 .88 JUSTIFICATION (REASONS) FOR CHANGE ORDER Th is change order is to request that an additional 147 Calendar Days (CD) be added to this contract due to ATMOS Energy having to relocate or upgrade supply lines on Foch St , Granger St , Peach St & Washington Ave. OFFICIAL RECORD CITY SECRETARY FT, WORTH, TX 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. ~~~~~~~~__i;_~---i-~~~~~~~-L-~~~~ ~~~~~====----~~~~--.sl..~~-::::!.::_~~~-~"=-J,J..}.~~t ~ t--=f,~~b;ifi~------t--;,;-~=---:::--~~~~~----t\----J---~~41J ~ L__ __ M_&c_N_um_be_r -===:t=:::::==---------~----====------!~'¢ 0 6 -14-12 A09:28 IN \) ~ City of Fort Worth Change Order Request Project Name! HMAC Surface Overlay ( 2011-12) At Various Locations Client Pmject #(s)j C293-541200-209620173083 City Project No : 01730 Project Description HMAC Surface Overlay Throughout the City l/1t 11 -tol City Sec # 42079 DOE : 6675 Contractor! JLB Contracting , LLC City Project Mgr. I Kristian Sugrim Change Order# Date 5/30/2012 (817) 392-8902 City Inspector Anthony Host (817) 223-2281 Enter Department(s) to the Right and TPw//// (:;ii' !~ Contract Time "' ~ TQ als Contract Day Type (CD) Original Contract Amount $918 ,529.50 $918 ,529 .50 120 Extras to Date Credits to Date \ 1111 \ -' Pend ing Change Orders (in M&C Process) l I Contract Cost to Date $918 ,529 .50 $918 ,529 .50 120 !Amount of Proposed Change Order $0.00 147 Revised Contract Amount $918 ,529 .50 $918 ,529 .50 267 Original Funds Available for Change Orders $0 .00 Remaining Funds Available for th is CO $0 .00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS% OF ORIGINAL CONTRACT 0.00% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $1 ,148 ,161 .88 JUSTIFICATION (REASONS) FOR CHANGE ORDER Th is change order is to request that an additional 147 Calendar Days (CD) be added to this contract due to ATMOS Energy having to relocate or upgrade supply lines on Foch St , Granger St , Peach St & Washington Ave . 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 aris ing out of, or inc idental to , the above Change Order. Date 0-S-/ M&C Number FORT WORTH ., ~ City of Fort Worth Change Order Request Project Name! HMAC Surface Overlay ( 2011-12) At Various Locations Client Project #(s)! C293-541200-209620173083 City Project No : 01730 Project Description HMAC Surface Overlay Throughout the City l/1t'71 (t I City Sec# 42079 DOE : 6675 Contractor! JLB Contracting , LLC City Project Mgr.! Kristian Sugrim Change Order# Date 5/30/2012 (817) 392-8902 City Inspector Anthony Host (817) 223-2281 Enter Department(s) to the Right and .... Contract Time TPW ., , Totals Contract Day Type (CD) Original Contract Amount $918 ,529.50 $918 ,529 .50 120 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $918 ,529 .50 $918 ,529 .50 120 !Amount of Proposed Change Order $0.00 147 Revised Contract Amount $918,529 .50 $918 ,529 .50 267 Original Funds Available for Change Orders $0 .00 Remaining Funds Available for this CO $0.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.00% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $1 ,148 ,161 .88 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order is to request that an additional 147 Calendar Days (CD) be added to this contract due to ATMOS Energy having to relocate or upgrade supply lines on Foch St, Granger St , Peach St & Washington Ave . (rll J17_ 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 aris ing out of, or incidental to , the above Change Order. Contractor's Com an Name Contractor Name JLB Contractin , LLC S.4- M&C Number M&C Date Approved FORT WORTH . ~ City of Fort Worth Change Order Request \ ' Project Namel HMAC Surface Overlay ( 2011-12) At Various Locations City Sec # 42079 .__ _____ ____. Client Project #(s)I C293-541200-209620173083 City Project No : 01730 DOE : 6675 Project Description HMAC Surface Overlay Throughout the City Contractor! JLB Contracting , LLC City Project Mgr . I Kristian Sugrim (817) 392-8902 Change Order# Date 5/30/2012 City Inspector Anthony Host (817) 223-2281 Enter Department(s) to the Right and TPW Totals Contract Time Contract Day Type Original Contract Amount $918 ,529 .50 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $918 ,529 .50 !Amount of Proposed Change Order $0.00 Revised Contract Amount $918 ,529 .50 Original Funds Available for Change Orders Remaining Funds Available for this CO $0 .00 Additional Funding (if necessary) CHANGE ORDERS to DA TE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) JUSTIFICATION (REASONS) FOR CHANGE ORDER (CD) $918 ,529 .50 120 $918 ,529.50 120 147 $918 ,529 .50 267 $0 .00 0.00% $1,148 ,161 .88 This change order is to request that an additional 147 Calendar Days (CD) be added to this contract due to ATMOS Energy having to relocate or upgrade supply lines on Foch St , Granger St , Peach St & Washington Ave . ' J ' ( - 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 Contract Si nature Date I , lnsoector/lnsoection Supervisor , . 10ate Project Manager/Proaram Manaaer Date 1 ..... ~ 1, ... v-,, -I ·- Assistant Director (Deot) Date Director, Contracting Department (Dept) Date .. Assistant €ity Attorney Date Assistant City Manaaer Date r . ·, ;I . I Council Action if reQu ired) M&C Number I -I M&C Date Approved I I •. ~ fORTWORTH -----.---- Project Name Client Project# City of Fort Worth Change Order Additions HMAC Surface Overlay ( 2011-12) At Various Locations C293-541200-209620173083 City Project No : 01730 DOE : 6675 Project Description HMAC Surface Overlay Throughout the City Contractor JLB Contracting , LLC Change Order # City Project Mgr. ...__K_ris_ti_an_S_u..._gr_im ___ ___.(_81_7) ..... 3_9_2-_89_0_2 __ ___. City Inspector Anthony Host ADDITIONS 11 t:M Ut:.:>LiKII"' 1 IUN Ut:I"' I c.ity Unit NA 11me Only 11-'W 14/.UU uays Change Order Additions Page 1 of 2 City Sec# 42079 Date 5/30/2012 (817) 223-2281 Unit (.;OSI 1ota1 ;i>U.Ul. ;i,u .uu TPW $0 .00 Sub Total Add1t1ons :t,U .00 Change Order Additions Page 2 of 2 FORT WORTH ------.---City of Fort Worth Change Order Deletions Project Name HMAC Surface Overlay ( 2011-12) At Various Locations Client Project# C293-541200-209620173083 City Project No : 01730 Project Description HMAC Surface Overlay Throughout the City Contractor JLB Contracting , LLC DOE : 6675 Change Order # City Project Mgr. _K_ris_ti_an_S_u~gr_im ____ ~(8_17-)_3_92_-8_9_02 __ ~ City Inspector Anthony Host DELETIONS 11 t:M ;t-{lt-'IIUN Ut:t' I u.iy Unit Change Order Deletions Page 1 of 2 City Sec# 42079 Date 5/30/2012 (817) 223-2281 Unrt t,;ost Total TPW $0 .00 Suo I otal ue1elions 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: BuySpeed No (T/PW): HMAC 2011-12 Surface Overlay @ various locations P0-11-00067 500 BuySpeed No (Water): City Project No : Contract No : 0 .0 .E. No : Attachment to Change O rder No: Today's Date : Original Contract Amoun t Extras to Date : Credits to Date : Contract Amount to Date : N/A 01730 CS42079 6675 1 5/31/12 Amount of Proposed Change Order: Revised Contract Amount: Contingency Funds Avail. for Admin . Change O rders : Remaining Funds Available for Change Orders : Additional Funding (if necessary): Additional Time Requested: 147days Prepared By : Chri.-•· · - Original M & C, C-25016, approved 07-19-11 TOTAL $ 918,529.50 $ $ $ 918,529.50 TIME NLY $ 918,52 .60 $ $ $ \ PROJECT SUMMARY SHEET (Change Order Attachment) PROJECT NAME: BuySpeed No (T/PW): HMAC 2011-12 Surface Overlay @ various locations P0-11-00067500 BuySpeed No (Water): NIA City Project No: 01730 Contract No : CS42079 D.O .E. No : 6675 Attachment to Change Order No : 1 Today's Date: 5/31/12 Original Contract Amount: Extras to Date : Credits to Date : Contract Amount to Date: 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: 147 days Original M & C, C-25016, approved 07-19-11 TOTAL $ 918,529.50 $ $ $ 918,529.50 TIME ONLY $ 918,529.50 $ $ $ Prepared By: Christy Ezernack T/PW Construction Services •,