Contract 2020-067A.16DocuSign Envelope ID: 3980721B-73E8-4BF5-8D63-99078375625C
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55
Bid Number: RFB 19-051
Change Order Number: 16
Change Order Date: Feb 24, 2022
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).
Deductive Change Order - Miscellaneous grout.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 4,310,565.37
B.
AMOUNT OF THIS CHANGE ORDER:
$-11,070.00
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
% -0.3%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 171,258.30
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 160,188.30
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS
(E/A): 10% Maximum
% 3.7%
G.
NEW CONTRACT VALUE (A+E)
$ 4,470,753.67
This Change Order is not valid without the following signatures:
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CONTRACTOR
Date PROJECT ARCHITECT / ENGINEER Date
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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 $100,000 OR 10% of the original
contract amount for construction projects; 3) the funds are not available in the approved budget for the department.
CITY OF CLERMONT ATTEST:
MAYOR Date CITY CLERK Date
Rev. 1-1-2021
DocuSign Envelope ID: 3980721B-73E8-4BF5-8D63-99078375625C
-• • •
0 -
• Unit Price
Extended Price
GROUT
-$ 11,070.00
4.14
GROUT FILL EXISTING 8" WM
1
LS
-$ 4,500.00
-$ 4,500.00
6.31
BALANCE GROUT FILL 8" MAIN
1
LS
-$ 4,722.00
-$ 4,722.00
BLOCK PURCHASED FROM PUBLIX WORKS
12
PALLET
-$ 154.00
-$ 1,848.00
TOTAL -$ 11,070.00
CHANGE ORDER TOTAL $ (11,070.00)
DocuSign Envelope ID: 3980721B-73E8-4BF5-8D63-99078375625C
pp; HALFF
VIA EMAIL jmaiworm(cDclermontfl.or
February 24, 2022
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 #16 DEDUCT, MISCELLANEOUS GROUT
Dear Mr. Maiworm:
I have reviewed Change Order #16 by Traverse Group, Inc., for miscellaneous grout and
recommend approval for a credit in the amount of $11,070.00. Should you have any questions,
please feel free to contact our office.
Sincerely,
HALFF
Duane K. Booth, P.E.
Operations Manager, VP
dboothahalff.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