2016-55 CHANGE ORDER FORM
Purchase Order Number 2016 0218 Bid Number 16 028
Change Order Number 4 Change Order DateAugust 8 2016
Project Name Interior Pool Surface&Tile Repair Department Parks and Recreation
Job Location Clermont Arts and Recreation Ctr
VENDOR INFORMATION
Company Name Aumiller Pools LLC
Address 2438 Summerfield Rd City St Zip Winter Park, Fl 32792
Contact Name BJ Aumiller Telephone (407) 808 5021
DESCRIPTION OF CHANGE
Alteration deviation addition or delet on caused by conditions encountered dunng construct on not covered by the specdcat ons and
drawings of the project(attach additional pages 4necessary)
Work will include rebuilding the pool gutter and steps to include all form work concrete steel bonding agents and
tile for the perimeter of the pool
ITEM AMOUNT
A ORIGINAL CONTRACT VALUE $ 29 300 00
• AMOUNT OF THIS CHANGE ORDER Council appro al required rfo e 15%of contract $ 47 275 00
pnce not toe ceed$49 999 OR if funds am not available in the approved budget for the Department
C PERCENT OF CONTRACT VALUE THIS CHANGE ORDER(B/A) to 161 3/
D AMOUNT OF PREVIOUS CHANGE ORDERS $ 6 560 00
E TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D) $ 53 835 00
F PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A) 15/ Maximum % 183 7%
G NEW CONTRACT VALUE(A+E) $ 83 135 00
1 . 1 • - • r. - 1 • - • , 1 • r - • • I1 • 1 .
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(CON ��� Date PROJECT ARCH ECT/ENGINEER Date
eldre/ 71,e, 4 D/I7/It0
DEPARTMENT DIRECT R e PURCHA ADD . C •R/CITY MANAGER Date
110.
Change Orders over 15/ not to exceed$49 999 of the anginal contract 0-������IIIIInot budgeted require the following signatures
CITY OF RMONT ATTEST
Gail L Ash Mayor Date Tracy Ackroyd City C Date
Rev 9-29 15