Contract 2019-55A.16 - COF 06.04.2020DocuSign Envelope ID: 052A1082-861C-4B5A-8DF3-FCAD47877052
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number: RFB 19-051
Change Order Number 16 Change Order Date: June 4, 2020
Project Name: Streetscapes Phase 1 Department: Environmental Svcs.
Job Location: West Ave. and W. Osceola
VENDOR INFORMATION:
Company Name: Traverse Group, Inc.
Address: P.O. Box 121754 City, St., Zip: Clermont, FL 34712
Contact Name: Alicia Roehn 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).
Exploratory rate and work hours for utilities locate. Rate includes utility investigations with man hours, survey
crew hours and excavator with operator. All are essential in exploration to determine where existing utilities are
located underground and depth.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE
$ $ 4,866,278.23
B.
AMOUNT OF THIS CHANGE ORDER:
$ $ 14,400.00
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A)
% 0. '3 -3Sari-
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 178,345.00
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D)
$ 478,345.6E)—
F•
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% 4. O-,3-ma§-
G.
NEW CONTRACT VALUE (A+E)
$ -S,044,623.2-3-
FF
L99-2,,145
This Change Order is not valid without the following signatures:
1`5
DO -Signed by.
6/4/2020
DocuSlgn by:
6/4/2020
CONTRACTOR
Date
YS:jffd°iARCHITECT / ENGINEER
Date
D—Slgne by:
6/4/2020
DocuSlgned by:
6/4/2020
DIRECTOR
Date
��7 13 54D6
PURCHASING DIRECTOR / CITY MANAGER
Date
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:
Gail L. Ash, Mayor Date Tracy Ackroyd Howe, City Clerk Date
Rev. 3-30-2020
DocuSign Envelope ID: 052A1 082-861 C-4B5A-8DF3-FCAD47877052
100 - GENERAL
Price I Extended Price
14,400.00
1.13 EXPLORATORY CREW RATE - THIS RATE
INCLUDES UTILITY INVESTIGATIONS WITH MAN
HOURS, SURVEY CREW HOURS AND
EXCAVATOR WITH OPERATOR. ALL ARE 160 HRS $ 90.00 $ 14,400.00
ESSENTIAL IN EXPLORATION TO DETERMINE
WHERE EXISTING UTILITIES ARE LOCATED
14,400.00