HomeMy WebLinkAboutContract 2025-022A CO2Docusign Envelope ID: 14538DB8-C4EE-4B39-8B4F-7B9F3CAB533E
CHANGE ORDER FORM
Contract / P.O. Number: 2025-022 / 20251642 Bid Number: RFB 25-051
Change Order Number: 2 Change Order Date: Jun 19, 2025
Project Name: 2025 Street Resurfacing Services Department: Public Services
Job Location: Oakley Seaver Dr
VENDOR INFORMATION:
Company Name: Superior Asphalt, Inc.
Address: P.O. Box 2489 City, St., Zip:Oneco, FL 34264
Contact Name: Greg Wasson, Project Estimator Telephone:(352) 678-3537
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: Additional locations for street repair services for the following locations:
1. Oakley Seaver Drive and Sandhill Boulevard
2. Oakley Seaver Drive and Hunt Trace Boulevard
See attached quote.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 476,825.00
B.
AMOUNT OF THIS CHANGE ORDER:
$ 21,000.00
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
% 4.4%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 112,040.00
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 133,040.00
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% 27.9%
G.
NEW CONTRACT VALUE (A+E)
$ 609,865.00
This Change Order is not valid without the following signatures:
DocuSigned by:
VtiLAJA, ttASJ,a& 8/5/2025
OP9�@;2 Date
PROJECT ARCHITECT / ENGINEER Date
FsDocuSigned by: DS Signed by:
fbMn l bVWA S6V1 8/5/2025 K& you 8/6/2025
P� ich I�PF DIRECTOR Date REMENT D*Er oaDanE... Date
CITY MANAGER
Council approval is required if change order(s): 1) exceeds 10% of the original contract amount for construction projects; 2) the
funds are not available in the approved budget for the department.
CITY OF CLERMONT
Signed by:
8/7/2025
Y61k96BE13984B7... Date
ATTEST:
FTDocuSigned by:
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T 10 14L�lan.. Date
Rev. 3-27-2025
Docusign Envelope ID: 14538DB8-C4EE-4B39-8B4F-7B9F3CAB533E
Superior Asphalt, Inc. Superior
P.O. Box 15025 Asphalt, Inc.
Brooksville, FL 34604
Phone: (352) 678-3537
Fax: (352) 678-3660
Request for Change Order
Project Name: 2025 City of Clermont Resurface RCO No.: 02
Client:
City of Clermont
Date:
June 11, 2025
Attention:
James Maiworm
Project No:
252023
Phone No.:
321-482-0490
Contract No.
2025-022
Fax No.:
Project
Location:
Oakley Seaver
Sandhill View
E-Mail:
imaiworm(a)clermontfl.org
Request for Change Order Description
Scope of Work:
1) Mill and pave turnouts on Oakley Seaver Dr and Sandhill Blvd.
2) Mill and pave intersection of Oakley Seaver Dr. and Hunt Trace Blvd
Mill, Pave and Striping 1360 square yard = $21,000.00
Impact on Project Schedule:
N/A
Exclusions:
N/A
Contract Price Adjustment: + $ 21,000.00
Lump Sum
Submitted by:
Please respond
by:
Accepted by:
Date:
Robert Mellette
June 11, 2025
(date)
Signature:
Signature:
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