Contract 2020-067A.10DocuSign Envelope ID: 47F52677-DF6D-4056-B572-AEBOA7BO508E
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number: RFB 19-051
Change Order Number: 10 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 - Additional parking in Minneola Ave., sidewalk and drainage revisions.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 4,310,565.37
B.
AMOUNT OF THIS CHANGE ORDER:
$ 34,251.16
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
% 0.8%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 109,423.02
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 143,674.18
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% 3.3%
G.
NEW CONTRACT VALUE (A+E)
$ 4,454,239.55
This Change Order is not valid without the following signatures:
DocuSigned by: DocuSigned by:
�_O/� 8/19/2021
396EE3AC046D48F_. 97CC96F6EBA64F2...
CONTRACTOR Date PROJECT ARCHITECT / ENGINEER
EDocuSigned by:
fb" bVt"S6V'
014063B8FF414OF...
DEPARTMENT DIRECTOR
8/20/2021
Date
DocuSigned by:
431F57D413554D6...
PROCUREMENT DIRECTOR /
CITY MANAGER
8/19/2021
Date
8/20/2021
Date
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 •
CORNER:CHANGE ORDER 10 - ADDT PARKING MINNEOLA AVE; MISC CONCRETE SIDEWALK AND DRAINAGE REVISIONS
R•HOME
L.N. General Description QtY. Unit
Misc Concrete Sidewalk & Drainage Revisions 5+75R (Pepe's Corner) $ 4,682.56
1.11
Survey
1
LS
$ 300.00
$ 300.00
2.13
Remove sidewalk to replace ADA mats (7+75R
Driveway and Corner Pepe's)
326
SF
$ 1.95
$ 635.70
10.1
4" Concrete Sidewalk
326
SF
$ 6.75
$ 2,200.50
11.1
ADA Mats
60
SF
$ 25.00
$ 1,500.00
1.2
Payment and Performance Bond - Increase due
to bonding charge(s) by Bonding Company (1%)
1
LS
$46.36
$ 46.36
TOTAL $ 4,682.56
Drainage Improvements Becker Funeral Home $ 5,082.32
2.13
Remove existing concrete
160
SF
$ 1.95
$ 312.00
2.19
Saw cut concrete
56
LF
$ 1.25
$ 70.00
5.43
10x6 Sewer wye
2
EA
$ 250.00
$ 500.00
6.3
6" Cleanouts
3
EA
$ 150.00
$ 450.00
6.2
6" Laterals
2
EA
$ 750.00
$ 1,500.00
5.44
4" Trench drains
20
LF
$ 110.00
$ 2,200.00
1.2
Payment and Performance Bond - Increase due
to bonding charge(s) by Bonding Company (1%)
1
LS
$50.32
$ 50.32
TOTAL $ 5,082.32
Additional Parking Minneola Ave $ 24,486.28
1.11
Survey
1
LS
$ 1,000.00
$ 1,000.00
1.12
Testing
1
LS
$ 350.00
$ 350.00
3.1
Stabalized Subgrade
170
SY
$ 3.00
$ 510.00
3.10
Excavate Roadway
135
CY
$ 6.00
$ 810.00
3.17
Remove Excess Material
135
CY
$ 6.00
$ 810.00
9.01
Geo Fabric for Pavers
1452
SF
$ 0.65
$ 943.80
9.02
Recycled Concrete Road Base
162
SY
$ 15.00
$ 2,430.00
10.12
6" Ribbon Curb
130
LF
$ 30.00
$ 3,900.00
11.02
Red Brick Pavers
1452
SF
$ 8.77
$ 12,734.04
11.05
White Brick Pavers
28
SF
$ 27.00
$ 756.00
1.2
Payment and Performance Bond - Increase due
to bonding charge(s) by Bonding Company (1%)
1
LS
$242.44
$ 242.44
TOTAL $ 24,486.28
CHANGE ORDER TOTAL $ 34,251.16