Contract 2020-067A.09DocuSign Envelope ID: 47F52677-DF6D-4056-B572-AEBOA7BO508E
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number: RFB 19-051
Change Order Number: 9 Change Order Date: Aug 19, 2021
Project Name: Streetscape Phase 2 Department: Public Services
Job Location: Minneola Ave. and Osceola Street
VENDOR INFORMATION:
Company Name: Traverse Group, Inc.
Address: P.O. Box 121754 City, St., Zip: Clermont, FL 34712
Contact Name: Alicia Roehn Telephone:352-409-6630
DESCRIPTION OF CHANGE:
Alteration, deviation, addition, or deletion caused by conditions encountered during construction not covered by the specifications and
drawings of the project (attach additional pages if necessary).
Additive Change Order - Drainage Structure 4+61 R Revive bldg and P&P Bonds price increase.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 4,310,565.37
B.
AMOUNT OF THIS CHANGE ORDER:
$ 6,618.03
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
% 0.2%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 102,804.99
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 109,423.02
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% 2.5%
G.
NEW CONTRACT VALUE (A+E)
$ 4,419,988.39
This Change Order is not valid without the following signatures:
DocuSigned by:
396EE3AC046D48F...
CONTRACTOR
EDocuSigned by:
fb" bVWA S6V1
014063B8FF414OF...
DocuSigned by:
8/19/2021 97CC96F6EBA64F2...
Date PROJECT ARCHITECT / ENGINEER
DocuSigned by:
8/20/2021E° S
431F57D413554D6...
Date
8/20/2021
DEPARTMENT DIRECTOR Date PROCUREMENT DIRECTOR / Date
CITY MANAGER
Council approval is required if change order(s): 1) exceeds $49,999; 2) exceeds the greater of $100,000 OR 10% of the original
contract amount for construction projects; 3) the funds are not available in the approved budget for the department.
CITY OF CLERMONT ATTEST:
MAYOR Date CITY CLERK Date
Rev. 1-1-2021
DocuSign Envelope ID: 47F52677-DF6D-4056-B572-AEBOA7B0508E
GROUP,TRAVERSE OF •
ORDERP CHANGE
lu- N. General Description Qty. Unit Unit Price Extended Price
Drainage Structure 4+61R Revive Bldg $ 6,618.03
5.13
18" HDPE
20
LF
$ 42.50
$ 850.00
5.42
18" HDPE 45 Bend
2
EA
$ 875.00
$ 1,750.00
5.18
Modified Type 6 Inlet
1
EA
$ 3,750.00
$ 3,750.00
10.1
4" Concrete Sidewalk
30
SF
$ 6.75
$ 202.50
$ 0.00
$ 0.00
1.2
Payment and Performance Bond - Increase due
to bonding charge(s) by Bonding Company (1%)
1
LS
$65.53
$ 65.53
TOTAL $ 6,618.03
CHANGE ORDER TOTAL $ 6,618.03