Contract 2019-55A CO21 (1)Docusign 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:
�/\ f 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
5DocuSigned by: DS Signed by:
fboVuU?FF�jaV1UnSOVt 8/14/2024�7a81968A394ceS 8/14/2024
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
Escalation Clause JAan to July 2024 per Contract
See attached for backup
Fuel Onroad
Fuel Offroad
Concrete
Asphalt
I
1.2 Payment and Performance Bond - Increase due to addithonal
bonding charge(s) 2%
1 LS $ 3,103.62 $
1 LS $ 0.00 $
1 LS $ 12,939.93 $
1 LS $ 8726.76 $
1 LS
3,103.62
12,939.93
8,726.76
495.41
25,265.72
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