Contract 2019-55A CO21Docusign Envelope ID: A72901C9-35B9-42BE-8E01-50473A1D67A0
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 / 20231454
Change Order Number: 21
Project Name: Streetscape Phase 3
Job Location: Not Applicable
VENDOR INFORMATION:
Company Name: Traverse Group, Inc.
Address: P.O. Box 121754
Contact Name: Alicia Roehn
Bid Number: RFB 19-051
Change Order Date: Aug 14, 2024
Department: Public Services
City, St., Zip: Clermont, FL 34712
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 for allowance due to increase in fuel and concrete costs.
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:
Signed by:
8/14/2024
396EE3AC046D48F...
CONTRACTOR Date
AMOUNT
$ 7,210,249.68
$ 25,265.72
% 0.4%
$ 458,529.64
$ 483,795.36
% 6.7%
$ 7,694,045.04
PROJECT ARCHITECT / ENGINEER Date
DocuSigned by: ir�
Signed by:
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fbnjV1nw' 8/14/202�
... 8/14/2024
014063B8FF4140FE�8A394C8DEPARTMENT 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: A72901C9-35B9-42BE-8E01-50473A1D67A0
1.8
TEMP CONSTRUCTION FENCING
1
LS
$
2,500.00
$
2,500.00
1.10
MOT
1
LS
$
3,500.00
$
3,500.00
1.11
STAKE AND LAYOUT
1
LS
$
3,500.00
$
3,500.00
1.12
TESTING
1
LS
$
2,500.00
$
2,500.00
2.7
REMOVE CURB
600
LF
$
13.25
$
7,950.00
2.11
REMOVE ASPHALT
6000
SF
$
1.55
$
9,300.00
2.26
REMOVE CONCRETE BASE
6000
SF
$
6.65
$
39,900.00
3.1
12" SUBGRADE
866
SY
$
3.90
$
3,377.40
3.3
ROADWAY GRADING
866
SY
$
2.95
$
2,554.70
3.5
CURB GRADING
200
SY
$
6.30
$
1,260.00
3.10
EXCAVATE ROADWAY
200
CY
$
7.69
$
1,538.00
3.17
REMOVAL FILL
200
CY
$
7.95
$
1,590.00
3.18
FINAL DRESSING
1
LS
$
750.00
$
750.00
5.1
REMOVE EXISTING manhole
1
EA
$
1,750.00
$
1,750.00
5.6
REMOVE 15" RCP
300
LF
$
25.00
$
7,500.00
5.13
18" RCP
300
LF
$
89.95
$
26,985.00
5.17
STORM DRAIN MANHOLE
2
EA
$
4,665.00
$
9,330.00
9.2
6" RECYCLED CONCRETE ROAD BASE
700
SY
$
16.65
$
11,655.00
9.6
1" SP 9.5 ASPHALT BASE COURSE
700
SY
$
10.95
$
7,665.00
9.6.1
1" SP 9.5 ASPHALT OVERLAY
700
SY
$
8.95
$
6,265.00
9.7
TACK
700
SY
$
2.00
$
1,400.00
10.7
F CURB
600
LF
$
36.75
$
22,050.00
Docusign Envelope ID: A72901C9-35B9-42BE-8E01-50473A1D67A0
10.10 CONCRETE DRIVEWAYS
15.28 SOD
1.2 Payment and Performance Bond - Increase due to
additional bondinq charqe(s) 2%
3 EA $ 1,500.00 $ 4,500.00
2400 SF
$ 0.45 $ 1,080.00
1 LS $ 3,623.00
TOTAL $ 184,773.10
Docusign Envelope ID: A7290lC9-35B9-42BE-8EO1-50473AlD67AO
STREETSCAPE PHASE
ESCALATION CLAUSE -
QUARTERLY PER CITY REQUEST (2) JAN THROUGH JULY 2024
CONCRETE 3000PSI
BID $142.86 TTL YD P/CY +/- DUE BID
2/2024 $ 176.88 112 CY $ 34.02 $ 3,810.24 1/2024
3/2024 $ 176.55 32 CY $ 33.69 $ 1,078.08 2/2024
5/2024 $ 176.55 20 CY $ 33.69 $ 673.80 3/2024
6/2024 $ 176.55 39 CY $ 33.69 $ 1,313.91 4/2024
7/2024 $ 177.10 49 CY $ 34.24 $ 6,063.90 5/2024
6/2024
7/2024
$ 12,939.93
Concrete $ 12,939.93
Fuel Onroad $ 3,103.62
Fuel Offroad $ -
Asphalt $ 8,726.76
TOTAL ESCALATION INCREASE $ 24,770.31
FUEL (AVERAGE ON ROAD)
$ 3.19
TTL GLN P/GALLON
+/-
DUE BID
$ 3.78
723.18 GA
$ 0.59
$ 426.68
$ 4.00
671.81 GA
$ 0.81
$ 544.17
$ 3.90
236.25 GA
$ 0.71
$ 167.74
$ 3.83
370.87 GA
$ 0.64
$ 237.36
$ 3.74
593.63 GA
$ 0.55
$ 326.50
$ 3.63
786.66 GA
$ 0.44
$ 346.13
$ 4.02
1271.15 GA
$ 0.83
$ 1,055.05
$ 3,103.62
FUEL (AVERAGE OFF ROAD)
$ 3.19 TTL GLN P/GALLON +/-
ASPHALT 9.5
DUE BID $ 62.00 TON P/TON
2/2024 $ 95.17 63.03 TNS
3/2024 $ 99.64 76.58 TNS
5/2024 $ 100.58 10.05 TNS
6.2024 $ 85.20 145.08 TNS
+/- DUE
$ 33.17 $ 2,090.71
$ 37.64 $ 2,882.47
$ 38.58 $ 387.73
$ 23.20 $ 3,365.86
$ 8,726.76