Contract 2020-067A.12DocuSign Envelope ID: 8F3C8F72-36DC-439C-B06A-8A8D50BF36F3
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number: RFB 19-051
Change Order Number: 12 Change Order Date: Oct 5, 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 - 8x6 Sewer Tap and 6" Sewer service for Becker Funeral Home
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 4,310,565.37
B.
AMOUNT OF THIS CHANGE ORDER:
$ 18,913.73
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
% 0.4%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 152,915.68
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 171,829.41
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% 4.0%
G.
NEW CONTRACT VALUE (A+E)
$ 4,482,394.78
This Change Order is not valid without the following signatures:
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10/5/2021 5m t' k 664 10/5/2021
396EE3AC046D48F... 97CC96REBA64F2...
CONTRACTOR Date PROJECT ARCHITECT / ENGINEER Date
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D11ocuSigned by: D^ocuSgned by:
lbin" j�jV1"Sb1� 10/11/2021 E44 ��610/5/2021
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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: 8F3C8F72-36DC-439C-B06A-8A8D50BF36F3
:tell] •
• •
-T M-1 � I — • —F—,IUnit Price Extended Price
EMERGENCY WORK - REPIPE REAR OF BUILDING TO EXISTING LINE $ 18,913.73
PLUMBER INVESTIGATION AND RELOCATION
LS
1
$ 4,400.00
$ 4,400.00
6" HDPE GRADE DIRECTIONAL BORE
80
LF
$ 90.00
$ 7,200.00
MAXI ADAPTER PVC TO CLAY COUPLING
2
EA
$ 300.00
$ 600.00
6" MAXI ADAPTER HDPE TO PVC
2
EA
$ 285.00
$ 570.00
SAW CUT AND DEMO CONCRETE
1
LS
$ 750.00
$ 750.00
TIE IN TO EXISTING SEWER MAIN
1
EA
$ 2,093.73
$ 2,093.73
CONCRETE (5 YRD MIN)
5
CY
$ 200.00
$ 1,000.00
FITTINGS AND CLEAN OUTS
1
LS
$ 1,950.00
$ 1,950.00
SOD
1
LS
$ 350.00
$ 350.00
$ 18,913.73
DocuSign Envelope ID: 8F3C8F72-36DC-439C-B06A-8A8D50BF36F3
mom HALFF
VIA EMAIL imaiworm(cDclermontfl.or
October 4, 2021
James Maiworm
Assistant Director Public Services
City of Clermont
3335 Hancock Road
Clermont, Florida 34711
RE: DOWNTOWN STREETSCAPE PHASE 2 (AVO #043826.078)
CHANGE ORDER #12, BECKERS SEWER
Dear Mr. Maiworm:
I have reviewed Change Order #12 by Traverse Group, Inc., and recommend approval in the
amount of $18,913.73. Should you have any questions, please feel free to contact our office.
Sincerely,
HALFF
Duane K. Booth, P.E.
Operations Manager, VP
dbooth(a-)halff.com
DKB:am
cc: Stoney Brunson, City of Clermont (via email)
George Beach, City of Clermont (via email)
Alicia Roehn, Traverse Group, Inc. (via email)
Halff Associates, Inc. 1902 N. Sinclair Avenue I Tavares, FL 32778 1 (352) 343-8481