Contract 2020-067A.04DocuSign Envelope ID: 5705EEOA-37F6-4EF6-876D-ED53D4D4DA43
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55
Bid Number: RFB 19-051
Change Order Number: 4
Change Order Date: Apr 21, 2021
Project Name: Streetscape Phase 2
Department: Public Services
Job Location: Minneola Ave. and Osceola Street
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).
Additice change order - 7th Street trail ramps & crosswalk; structure D214 18-inch stormdrain; 2-inch water service
Minneola Ave. STA 11+00.
ITEM AMOUNT
A. `ORIGINAL CONTRACT VALUE: $ 4,310,565.37
B. AMOUNT OF THIS CHANGE ORDER: $ 12,307.41
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%
D. AMOUNT OF PREVIOUS CHANGE ORDERS: $ 56,794.62
E. TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D): $ 69,102.03
F. PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum % 1.6%
G. NEW CONTRACT VALUE (A+E) $ 4,379,667.40
This Change Order is not valid without the following signatures:
�— DocuSigned by: DocuSigned by:
M6& �Ot _ 4/23/2021 L 4/23/2021
sDae�.-
CONTRACTOR Date PROJECT ARCHITECT / ENGINEER Date
DocuSigned by: Docuftned by:
Sl bVWA Sbin, 4/26/2021 4UMI S 4/26/2021
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
NOT REQUIRED
ATTEST:
MAYOR Date CITY CLERK
Date
Rev.1-1-2021
DocuSign Envelope ID: 5705EEOA-37F64EF6-876D-ED53D4D4DA43
Un1t Price
Extended Price
7th Street Trail Ramps and Crosswalk
1.6
Asbuilts
1
LS
$ 50.00
$ 50.00
2.7
Remove and Dispose of Existing Curb
50
LF
$ 10.00
$ 500.00
2.13
Remove and Dispose of Existing Concrete
225
SF
$ 1.95
$ 438.75
3.5
Curb Grading
10
SY
$ 5.00
$ 50.00
3.6
Sidewalk/Driveway Grading
34
SY
$ 4.00
$ 136.00
10.2
6" Concrete
304
SF
$ 10.95
$ 3,328.80
10.6
24" Valley Gutter
30
LF
$ 35.00
$ 1,050.00
10.9
Handicap Ramp Curbs
36
LF
$ 27.00
$ 972.00
1.2
Payment and Performance Bond - Increase due to bonding
1
LS
$65.26
$ 65.26
TOTAL $ 6,590.81
Structure D-21418" Stormdrain Subout $1,626.10
1.6
Asbuilts
1
LS
$ 50.00
$ 50.00
5.13
18" RCP
32
LF
$ 42.50
$ 1,360.00
5.41
Brick Plug 18" Stubout
1
EA
$200.00
$ 200.00
1.2
Payment and Performance Bond - Increase due to bonding
1
LS
$16.10
$ 16.10
TOTAL $1.626.10
2" Water Service Minneola Ave STA 11+00 $ 4,090.50
1.6
Asbuilts
1
LS
$ 50.00
$ 50.00
4.3
Remove Existing Water Service
80
LF
$ 10.00
$ 800.00
4.4
New Water Service
80
LF
$ 20.00
$ 1,600.00
4.17
2" Poly Water Service
90
LF
$ 10.00
$ 900.00
7.20
4" Bore
20
LF
$ 35.00
$ 700.00
1.2
Payment and Performance Bond - Increase due to bonding
charge(s) by Bonding Comp an ( 1 %)
1
LS
$40.50
$ 40.50
TOTAL $ 4,090.50
CHANGE ORDER TOTAL $ 12,307.41