Contract 2024-007A CO3DocuSign Envelope ID: 5C4A6A47-C6C9-452E-B9E5-28E7lA401A1E
CHANGE ORDER FORM
Contract / P.O. Number: 2024-007 / 20243134
Change Order Number: 6
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: Jun 21, 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 - Time and material for the addition of cameras in the total amount of $10,795.20.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$
557,913.73
B.
AMOUNT OF THIS CHANGE ORDER:
$
10,795.20
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
%
1.9%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$
17,292.80
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$
28,088.00
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
%
5.0%
G.
NEW CONTRACT VALUE (A+E)
$
586,001.73
This Change
Order is not valid without the following signatures:
DocuSigned by: DocuSigned by:
6/21/2024 6/21/2024
E396EE3AC046D48F... B654D8_
CONTRACTOR Date PROJECT ARCHITECT / ENGINEER Date
EsDocuSigned by: DocuSigned by:
fb" bVWASbV1 6/24/2024 4 S�� 6/24/2024
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: 5C4A6A47-C6C9-452E-B9E5-28E7lA401A1E
TRAVERSE GROUP, MC • CITY OF CLERMONT VICTORY POINTE PARKING LOT C006
Time & Material lot, added Cameras per Paul Erickson
L.N I General Description _ _ j City j Unit lunit Prier � Extended Price
& Material for added Cameras per Paul Erickson
$ 10,795.20
Time & Materials for added Cameras at Victory Pointe Parking LS
Lot per the direction of Paul Erickson 1 $ 10,795.20 $ 10,795.20
Included in Change Order:
Install junction boxes (2) at light poles and make final conduit
terminations or raceways for camera fiber (cabling to be
installed by others)
Provide new circuitry, power connections and install
receptacles for fiber converters at each of the (2) light poles
listed above
Miscellaneous rework made during ongoing construction
TOTAL $ 10,795.20