HomeMy WebLinkAboutContract 46980-CO1 C"SECRE'TARY
FoRTWGRTH. City of Fort Worth (:010RACI NO-
"114�` Change Order Request Breakdown
Project Name Emulsified Aspahtt Fog Seal Application 2015 City Sec#
Client Project#(s) Prod ect#02537
Contractor lnnovafive idway Roadway PME:Tar1c1u6 lsiam� inspector Toby Crabtree
Change Order Submittal# Date 1 9/23/20I5 7�
Dept. T/PW Contract Time
Totals JCD�
Original Contract Amount $192,000.00 $192,000,00 30_
Extras to Date
Credits to Date
Pending Change Orders(in MSC Process)
Contract Cost to Date $192,000,00 $192,000.00 30
JAmount of Proposed Chanue Order 1L9,360.00
$39,3%00
Revised Contract Amount 1231,360.00 $231,360.00 30
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $39,360.00
$39,360.00
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS Y.OF ORIGINAL CONTRACT ,
,2 , 0/
05 04
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACTCOST+25%) $,24,,O,,000,r,(){),,,
.. .......
This change order is to allow payment to the contractor for additional mastic emulsion(Onyx)to The needed for higher average rate of
applicatiori(0.25 gaUSY)than standard average rate of application(0,,20 gaUSY).The standard fog seal requires single coat of application but
the manufacturer of Onyx recommends two coats of applicafion with 0.125 gaVSY each.
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Date
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23,9015 .......................... ..............
Cl Py, 11 I J........... OFFICIAL RECURD
CITY SECRETARY
FT. WORT1111,
FE W * City of Fort Worth
Change Order Additions
ApiwAIName CKYSW,# [ 698-0—,
91t Pro*t
CI t# 253�
L- # iE 0—-----—------————---------------—--——---
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Change Order Submittal# ro Data E:)d23 01 5
ADDITIONS
FEW-1 DrscR777N DEPT Qty no Unit cost Total
Fog Seal Applicafion wit TRIVISS orApprovea equal 77T— bw Sm $39,36
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$39,360.010
'39
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--7,ub Total—Addwns 3 , 01
Chavige Order Addifions Page 1 of 1
City of Fort Worth
Change Order Deletions
Pirojed I4,a EwacaN wA�e.I!foq,'LWAppLmb 20 5 CRY See
CUM Project
poctorEl--wc—rm,-D
Change Ogler Submirmal# =1 Dime
DELETIONS
gTEM DESCRIPTION DE-P7—-----Ct-y Unit U-n-It-cu—St 70tal
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$000
!IPW
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Sub Total SDetetions 0
Change Order DOetrons Page 5 of I
M/SBE Breakdown for this Change Order
N1fS E t b Type of Service Amount for this- 0,,.
Total CQ'
Previous Change Orders
HATE AMOUNT
Total .p@�
CFW Change Order Approval St-COAppul Page 1 of
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthgovllnfrastructure Projects/02537 - Fog Seal Aoolication 2015/Contractor/Change Orders/Change Order 1
Breakdown CPN 02537.x1s
Attachments(0)
No Attachments have been added to this form.
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CFW Change Order Approval St-COAppO 1 Page 2 of
tORT WDRTH,& City of Fort Worth
Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal o.: C Su 0 .
Change Order o.: St-COAPP01 Date Started: '2015-09-28
City Sec. No.: 46980 „ � Date Due:
2.._0..15-1.0 09
Project Name: Emulsified Asphalt
a Seal Application 2015
02537 DOE Numbers:
Project Numbers: V .
Description: pre ervat.3.,on
t
Project Manager: Tariqul Islam City Inspector: :Toby Crabtree
Contractor: Irmovative Roadway Solutions
COUNCIL ACTION (If Required):
Log me
C Number: M&C e:
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days*
7PW $ 39,360.00 C293 541200 201640253783
j
Total Cost: $ 39,360,00 Total Requested Days:
Approval us:
https://projectpoint.buzzsaw.ca bz eb/Foi s/Fo nnt.as x?SiteI =51500 roces... 10/22/2015
CFW Change (]rdcI Approval St-COAppO] Page of
Approved: Yes
Comments:
User: Dan Sherbo
Date: 2015-09-287:40 PM
Approved: Yes
Comments: This CO is for higher rate of application of material per manufacturer's
recommendation.
User: Tariqu| Islam
Date: 2015-09-29 2:43PM
Approved: Yes
Comments:
User: Dan Sherbo
Date: 2015-10-059:16PM
Approved: Yes
Comments:
User: Tariqu/ Is|8nn
Date: 2015-10-06 8:24 AM
Approved: Yes
Comments:
User: Andy Anderson
Date: 2015-10-06 8:39 AM
Approved: Yes
Comments:
User: Doug VViersig
Date: 2015-10-085:36PM
Approved: Yes
Comments:
User: Doug Black
Date: 2015-10-12 5:02 PM
Approved: Yes
Comments:
User: Jay Chapa
Date: 2O15-1O-225:14 PM
Action Required:
hnn3://pr 'eclp0int.buzzsuvv.cnm/ bz_vvcb/Puoos/F0ouPrizd.aspr?Siteld=5l500&PrnCes... 10/22/7015