Contract 2019-55A.11 - COF 04.27.2020CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number:
Change Order Number:11 Change Omer Date: 4.27.2020
Project Name: STREETSCAPE PH 1 Department:
Job Location: WEST AVE AND W OSCEOLA ST
VENDOR INFORMATION:
Company Name: TRAVERSE GROUP, INC.
Address: PO BOX 121754 City, St., Zip: CLERMONT, FL 34712
Contact Name: ALICIA ROEHN Telephone: 352.409.6630
DESCRIPTION OF CHANGE:
AMeration, devialkv, addition, or deletron caused by conditions encountered during construction not covered by the specrwadons end
drawings of the project (attach additional pages y necessary).
SEWER/STORMDRAIN CONFLICT STA 12+00 TO 15+00, UPCHARGE FROM 18" HDPE TO 1023 ERCP.
SEE INDIVIDUAL BREAKDOWN
gym,
AMOUNT
A.
ORIGINAL CONTRACT VALUE
$ 3,997,913.13
B
AMOUNT OF THIS CHANGE ORDER:
S�
Must be within the overall scope of services in accordance with contract specilicallons.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A)
% 0.6%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 378,069.61
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D)
$ 401,616.61
Council approval roqquked #overS49,999 ($100,000Ibrconsbuc6on) of origkral contrad price OR If
funds are not swab to /n the aoDroved budot for the QpInOwd,
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% t{), 's
G.
NEW CONTRACT VALUE (A+E)
$ 4,399,529.74
C �NTRACTOR Date PROJECT ARCHITECT / ENGINEER Date
'DEPARTMENT DIRECTOR Date PURCHASING DIRECTOR / CITY MANAGER Date
Change Orders over 10%, not to exceed $49, 999 ($100, 000 for construction projects) of the original contract OR not
budgdl+ed, require the following signatures:
CITY OF GWRMONT ATTEST:
z A� zz4y�.I -Z-"> YS-/Z-Zd-Z
Gail L. Ash. Mayor Date Tracy Ackroyd How6, C6 Clerk Date
Rev. 12.6-19
Streetscape Phase 1: Sewer I Stonlidrain
Conflict
W Osceola
St -Up
di.arge
fro n) In " HDPE to
ORDER
L.N. General Description
Qty.
UnitlJnit Price
Extended Price
100 - GENERAL
S
500.00
1.11
jSurveyLayout
1
LS
$
500.00
$
500.00
500- STORM DRAINAGE
$
23,047.00
5.13
CREDIT 18" HDPE
160
LF
$
(42.50)
$
(6,800.00)
5.38
14x23 ERCP STA 12+00-15+00
160
LF
$
57.45
$
9,192.00
5.39
Storm Inlet Modification (Core/Cut) Structures D127;
EA
D125; D124; D128; D121; D120; D130; D131; DS10
9
$
2,295.00
$
20,655.00
$
23,647.00
2d