2013-81 CHANGE ORDER FORM
Purchase Order Number. Bid Number 12.- 006
Change Order Number. 2 Change Order Date 11/22/2013
Project Name Disston Ave Potable Supply Well Department 1E1.11/11 N11*IJTAL
Job Location: Clermont, Florida
VENDOR INFORMATION:
Company Name A C Schultes of Florida, Inc
Address. 11865 US Highway 41 City, St,Zip, Gibsonton, FL 33534
Contact Name. Kevin McDowell, P E Telephone: 813-341-3010
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)
Change order to zero out schedule of value line items with remaining budgets and line items that exceeded the
initial approved value to reduce overall contract value for project close-out. This change order will result in a
deduction to the contract value of$3,210 00.
ITEM AMOUNT
A ORIGINAL CONTRACT VALUE $ 533,375
B AMOUNT OF THIS CHANGE ORDER Council approval required if over 10%of contract 3,210
once,not to exceed$25,000 $
C PERCENT OF CONTRACT VALUE THIS CHANGE ORDER(B/A) % -0.60
D AMOUNT OF PREVIOUS CHANGE ORDERS $ 111,597 75
E TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D)' $ 108,387 75
F PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A)• 10%Maximum % 20 32
G NEW CONTRACT VALUE (A+E) $ 641,762 75
This Change Order is not valid without the following signatu
1)„-t(-1.
a NTTRRAC R Da -"MT CT ' "CHITE T/ENGINEER Date
VtiA 3 - �I ' 1 Z.-11-13
DEPART D CTOR Dat PURCHASIN .- 'NAGER/ I." MANAGER Date
Change Orders over 10%,not to exceed$25,000 of the original contract,require the following signatures
CITY OF CLEWM• ATTEST (/
))/6‘660d H. d Turville, Mayor 'ate Tracy Ackroyd,City Clerk Date
Rev 3-19-13
SECTION 00843
CHANGE ORDER FORM
Project: City of Clermont
Disston Avenue Potable Water Supply Well and
Eastside WRF Reclaime Water Supply Well
CHANGE ORDER NO. 2
DATE OF ISSUANCE: 11-22-13 CONTRACTOR: A.C. Schultes of Florida
EFFECTIVE DATE: 11-22-13 ENGINEER: Tetra Tech, Inc.
OWNER'S CONTRACT NO.:
The following changes are hereby made to the Contract Documents:
CHANGE IN CONTRACT PRICE: CHANGE IN CONTRACT TIMES.
Original Contract Pnce Original Contract Times
Substantial Completion. 150 days or July 13,2012
$533,375.00 Ready for fmal payment: 180 days or August 12,2012
days or dates
Net changes from previous Change Orders No.0 to Net change from previous Change Orders No._to
No 1 No.
$ 111,597.75 268 days
days
Contract Price prior to this Change Order Contract Times prior to this Change Order
Substantial Completion:418 days or April 7,2013
$644,972 75 Ready for fmal payment.448 days or May 7.2013
days or dates
Net(impasse)decrease of this Change Order Net Increase(decrease)of this Change Order
$3,210.00 NA
days
Contract Price with all approved Change Orders Contract Times with all approved Change Orders
Substantial Completion 418 days or April 7,2013
$641,762 75 Ready for fmal payment:448 days or May 7,2013
days or dates
MAG/slm/specs/s-1/CO#1_CO#2_00843
Tt#200-08310-10002 00843-1 102913
CHANGES ORDERED:
I. GENERAL This change order is necessary to cover changes in the work to be
performed under this Contract. The General Conditions, Supplementary Conditions,
Specifications and all parts of the Project Manual listed in Article 1, Definitions, of the
General Conditions apply to and govern all work under this change order.
Change Order No. 2
II. REQUIRED CHANGES: Zero out schedule of value line items with remaining
budgets and line items values that exceeded the initial approved value to reduce overall
contract value for project close-out, as shown below.
E Value of Items:Balance to 1
iChange Order 1 ,Bid Quantity ;Units Unit Price Completed !Finish 1
(Mobilization/Demobilization 1 1 LS , $15,020 50 $15,020.50 1 $0.00
General Requirements 1 LS $7,510.25 $7,510.25 I _ $0.00
Site Work I 1 LS $6,300 00 j $6,300 00 1 $0.00
CY
!Cement Grout,Installed 12 I $180
$360 00 i $1,800.00
!Limestone Gravel,___ 1 39 CY ! $155.00 $6,045.00 $0.00 ;
Pilot Hole Drilling(10-inch) 1100 LF $90.00 1 $103,590`00 1 ($4,590.00)
.Open Hole Drilling(23-inch) 50 j LF $150.00 $7,500.00 $0.00 p
'Geophysical Logging 1 i 1 L LS i $5,000.00 $5,000.00 , $0.00
Video Logging 1 1 1 LS $1,500.00 $1,500 00 ; $0.00
Dual Element Packer Testing 2 I EA $12,000.00 $18,000.00 , $6,000.00 1
Install and Remove Discharge Piping ! i
land Appurtenances 1 LS $5,000.00 f $5,000.00 $0.00
Change Order 1 Deduct l 1 { LS ($67,438.00) ($67,438.00); $0 0-0 I
,Total: $3,210.00 '
III. JUSTIFICATION: Project close-out.
IV. PAYMENT: The attached schedule of values is provided as Exhibit A and shows a
balance to finish of$3,210.00 from the revised contract(change order#1)after all work
was completed. Thus the net change order requested is minus $3,210.00. The new
proposed total contract value will be $641,762.75.
MAG/slm/specs/s-1/CO#1_CO#2_00843
Tt#200-08310-10002 00843-2 102913
V. APPROVAL AND CHANGE AUTHORIZATION:
Acknowledgments:
The aforementioned change, and work affected thereby, is subject to all provisions of the
original contract not specifically changed by this Change Order; and,
It is expressly understood and agreed that the approval of the Change Order shall have no
effect on the original contract other than matters expressly provided herein.
Change Order Request by: Tetra Tech Inc.
Change(s) Ordered by: City of Clermont
RECOMMENDED BY: ACCEPTED BY:
Tetra Tech ` ,C1 S(, 'l ak • 144 del C,
(Engineer) :.�• tor)
By ;4,l► 10/29/13 ire e��■11_ /012/3
4031'3!,ze�ignature) (Date) AVA I o• -d Signature)
Vice President Vic 4" )l am'►7"
(Title) (Title)
APPROVED BY:
City of Clermont, Florida
(Owner)
By:
(Authorized Signature) (Date)
END OF SECTION
MAG/slm/specs/s-1/CO#1_CO#2_00843
Tt#200-08310-10002 00843-3 102913
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