Contract 2024-052P CODocusign Envelope ID: OCE6FFBA-E71C-4lA9-9182-CCF67F1012B3
CHANGE ORDER FORM
Contract / P.O. Number: 2024-052 / 20250096
Change Order Number: 1
Project Name: Construction of Pickleball Courts
Job Location: Parks and Recreation Department
VENDOR INFORMATION:
Company Name: William Medley Construction
Address: 32132 Hickory Lane
Contact Name: Erik Medley
Bid Number: RFB 24-101
Change Order Date: Oct 15, 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 for additional equipment and labor to utilize dirt on site to raise the elevation to the agreed
height for a total cost of $4,675. See attached change order request for additional information.
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)-� 10/21/2024
9
CONTRACTOR Date
AMOUNT
$ 116,250.00
$ 4,675.00
4.0%
$
0.00
$
4,675.00
%
4.0%
$
120,925.00
PROJECT ARCHITECT / ENGINEER Date
Signed by: Docu,S{ig{ned, by:
aVwtAan 10/22/2024 vvV-V-� S 10/22/2024
E 34DB84F9 E431F57D413554D6...
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: OCE6FFBA-E71C-41A9-9182-CCF67F1012B3
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SPORTS CONSTRUCTION
Change Order Request #1
Contractor: Medley Sports Construction
PO BOX 777
Sorrento, FL 32776
Owner: City of Clermont
Attn. Arts and recreation center
3700 S Hwy 27, Clermont, FL 34711
This Change Order Request (CO#1) contains the following items as described below for the 6
new pickleball courts
1. Proposed Changes:
Additional equipment and labor to utilize dirt on site to raise the elevation to the agreed
height.
3 cy front end loader including fuel, delivery and maintenance- $3,625.00
1 Equipment Operator for 3 days @ 8 hr per day- $1050.00
TOTAL- $4,675.00
2. The contract sum prior to this Change Order was $116,250.00
3. The contract sum will be increased by this Change Order in the amount of $4,675.00
4. The new contract sum including this change will be $120,925.00
5. The new contract time will be an additional 3 -5 days.
6. The date of substantial completion will be an additional 3-5 days.
7. This agreement shall be signed by the contractor and owner below.
Docusign Envelope ID: OCE6FFBA-E71C-41A9-9182-CCF67F1012B3
Signature
date 9-23-24
Signature date