Contract 2024-007A CO2DocuSign Envelope ID: 7B0889DA-BAA8-4C37-9927-12DFE275B7AA
CHANGE ORDER FORM
Contract / P.O. Number: 2024-007 / 20243134
Change Order Number: 4
Project Name: Victory Pointe Parking Lot Const.
Job Location: Victory Pointe
VENDOR INFORMATION:
Company Name: Traverse Group, Inc.
Address: P.O. Box 121754
Contact Name: Alicia Roehn
Bid Number: N/A
Change Order Date: May 8, 2024
Department: Public Services
City, St., Zip: Clermont, FL 34711
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 - Conduit install for Police Department video cameras and light pole modifications in the total
amount of $4,245.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$
557,913.73
B.
AMOUNT OF THIS CHANGE ORDER:
$
4,245.00
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
%
0.8%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$
-19,802.20
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$
-15,557.20
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
%
-2.8%
G.
NEW CONTRACT VALUE (A+E)
$
542,356.53
This Change
Order is not valid without the following signatures:
DocuSigned by:
DocuSigned by:
5/8/2024 5/8/2024
E
396EE3AC046D48F...
6AA711E6BB654D8...
CONTRACTOR
Date PROJECT ARCHITECT / ENGINEER Date
EsDocuSigned by: DocuSigned by:
fbin l bVWA SbV1 5/9/2024 4 S�� 5/9/2024
014063B8FF4140F... 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
DocuSign Envelope ID: 7B0889DA-BAA8-4C37-9927-12DFE275B7AA
TRAVERSE GROUP, INC - CITY OF CLERMONT VICTORY POINTE PARKING LOT COIµ
Cooduh Install for Polite Department Video Cameras and Light Pole Modlficalion
Oty I Unit Junk Price I Extended Price
Conduit Install for Police Department Video Cameras and Light Pole Modifications $ 4,245.00
Conduit Install for Police Department Video Cameras and LS
Light Pole Modifications 1 $ 4,245.00 $ 4,245.00
TOTAL $ 4,245.00