HomeMy WebLinkAboutContract 43299-CO1FORTWORTH,
,U Y SECRETARY
CONTRACT NO. ti 3 Zq R Cfl I
City of Fort Worth
Change Order Request
Change Order No. Date TPW Project No. Funding (FAC)
One (1) 8/20112 Brennan Drainage R101-539410-020212009000
Repair: ENV 12-09 BSC
Facility and Project Description City Secretary Contract No.
Repair of French Drain for De -watering the Northern Slope, East of Improved Drainage Channel 43299
ORIGINAL CONTRACT AMOUNT................................................................ $ 4,850.00
EXTRAS TO DATE..................................................................... $ 0.00
CREDITS TO DATE.................................................................... $ 0.00
CONTRACT COST TO DATE.................................................................................................. $ 4,833.00
AMOUNT OF PROPOSED CHANGE ORDER ............................................. (ADD)....................... $ 1,212.50
BALANCE CONTRACT REMAINING....................................................................................... $ 1,229.50
REVISED CONTRACT AMOUNT............................................................................................. $ 6,062.50
IN ACCORDANCE WITH THIS CHANGE ORDER, THE CONTRACTOR SHALL:
• Provide two additional cleanouts along replaced drainage;
• Cap line from east of collection sump;
• Provide a bentonite barrier at capped location within the gravel pack surrounding the installed French Drain; and
• Provide an inlet seal into sump and increase the size of the discharge line from 2"OD to 4"OD.
All work to be performed in accordance with the Proposal specifications.
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
Effective Environmental, Inc (WWW.EFF-ENV.COM)
Original Contract Time Additional Approved Time To Date Approved Contract Time To Date Additional Time For This Change Order
NA NA NA NA
Contractor -
Effective Environmental, Inc.
Environmenta ostni Mana2te�r
Clarence Re
Director,
Douglas W. Wiersig, P.E.
Assistant CityY Manager- (/•J W
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Date Environmental Supervi Date
Roger Grantham /o • 3 . /Z
Date Assistant Director / TPW i n tal Date J
Michael A. Gange ly� I `�/F// L
Date Assistant City Attorne} Date
!o �� h 7-Art N. Bashor /y 4re`
Date Council Action (if Required)
/0�,9�/.Z ElApproved ElDisapproved NIA
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'Environmental Services Division
Change Order Form (11/10)
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX