Contract 2020-067A.11DocuSign Envelope ID: 5lB7B9D2-3D9B-43E1-9827-EOAD2A9602BF
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55
Bid Number: RFB 19-051
Change Order Number: 11
Change Order Date: Aug 23, 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 - Minneola Ave. curb and tree removal.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 4,310,565.37
B.
AMOUNT OF THIS CHANGE ORDER:
$ 9,241.50
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:
$ 143,674.18
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 152,915.68
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS
(E/A): 10% Maximum
% 3.5%
G•
NEW CONTRACT VALUE (A+E)
$ 4,463,481.05
This Change Order is not valid without the following signatures:
-E DocuSigned by:
396EE3AC046D48F...
CONTRACTOR
DocuSigned by:
8/23/2021
97CC96F6EBA64F2...
Date PROJECT ARCHITECT / ENGINEER
8/23/2021
Date
DocuSigned by: DocuSigned
, by:
E
�bint� bVt"SbV' 8/23/2021 4vvV-V-� atk" 8/23/2021
014063B8FF414OF... ,31F57D413554D6...
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: 51B7B9D2-3D9B-43E1-9827-EOAD2A9602BF
-• •
•
•
Unit Price
Extended Price mmmmd
MINNEOLA AVE
$ 9,241.50
2.07
REMOVE AND DISPOSE OF CURB (STA 5+00 L)
90
LF
$ 10.00
$ 900.00
2.14
REMOVE PALM TREES (2+20 R)
3
EA
$ 1,500.00
$ 4,500.00
10.5
D CURB ( STATION 5+00 L)
90
LF
$ 30.00
$ 2,700.00
105
D CURB ( STATION 3+20 R) POST OFFICE DRIVE
35
LF
$ 30.00
$ 1,050.00
1.02
Payment and Performance Bond - Increase due to bonding
charge(s) by Bonding Company (1%)
1
LS
$91.50
$ 91.50
TOTAL $ 9,241.50
CHANGE ORDER TOTAL $ 9,241.50