Contract 2024-008A CODocuSign Envelope ID: F639D24D-B7D5-444D-95FD-3599DOA37DE6
CHANGE ORDER FORM
Contract / P.O. Number: 2024-008 / 20243672
Change Order Number: 1
Project Name: Lake Felter Basketball Court Resurf.
Job Location: Lake Felter Park
VENDOR INFORMATION:
Company Name: William Medley Construction, Inc.
Address: PO Box 777
Contact Name: Erik Medley
Bid Number: RFB 24-042
Change Order Date: Mar 7, 2024
Department: Parks and Recreation
City, St., Zip: Sorrento, FL, 32776
Telephone:352-459-4436
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 in the amount of $2,100 for addition of lime -rock base + compaction to area that is 30' x 35'.
Laser -grade entire court space after addition and compaction.
ITEM
A. ORIGINAL CONTRACT VALUE:
B. AMOUNT OF THIS CHANGE ORDER:
Must be within the overall scope of services in accordance with contract specifications.
C. PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
D. AMOUNT OF PREVIOUS CHANGE ORDERS:
E. TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
F. PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
G. NEW CONTRACT VALUE (A+E)
This Change Order is not valid without the following signatures:
DocuSigned by:
k)-� 3/14/2024
9
CONTRACTOR Date
AMOUNT
$ 69,950.00
$ 2,100.00
%
3.0%
$
0.00
$
2,100.00
%
3.0%
$
72,050.00
PROJECT ARCHITECT / ENGINEER Date
DocuSigned by: DocuSigned by:
� FbV*OlA, 3/14/2024 � � Sum 3/14/2024
DC25FBE34DB84F9... 431F57D413554D6...
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