Contract 2020-067A.01DocuSign Envelope ID: 5705EEOA-37F6-4EF6-876D-ED53D4D4DA43
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number: RFB 19-051
Change Order Number: 1 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 G
Address: P.O. Box 121754
Contact Name: Alicia Roehn
, Inc.
City, St., Zip: Clermont, FL 34712
Tel e p h o n e :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).
Additive change order to provide conduit and bore duke energy, sewer storm conflict STA 3+30 D232A and drainage
issue becker rear parking & 8th St.
ITEM
A. I 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:
FADocuSigned by:
�tUA. f°b(,!r AA,
4/23/2021
CONTRACTOR
Date
AMOUNT
$ 4,310,565.37
$ 124,914.85
2.9%
$ 0.00
$ 124,914.85
% 2.9%
$ 4,435,480.22
E
ocu3lgned by:
_ 4/23/2021
PROJECT ARCHITECT / ENGINEER Date
L:F
LDoeu3igned by: DocuSigned by:
Sf6 1/� �AdA.S6V1 4/26/2021 �IASAaA, 6. VA.U, ais 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 ATTEST:
NOT REQUIRED
MAYOR Date CITY CLERK Date
Rev. 1 - 1 -2021
DocuSign Envelope ID: 5705EEOA-37F6-4EF6-876D-ED53D4D4DA43
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Un€t Price Extended Pnce
CONDUIT AND BORE DUKE ENERGY $118,804.35
8.2
F & 1 1-2 In. Sch 40 Conduits Per Duke Energy
Specifications
865
LF
$ 20.00
$ 17,300.00
8.4
F & 1 1-4 In. Sch 40 Conduits Per Duke Energy Specifications
510
LF
$ 20.00
$ 10,200.00
8.19
4" PVC Sweep w/ Concrete
25
EA
$ 75.00
$ 1,875.00
8.20
2" PVC Sweep w/ Concrete
35
EA
$ 25.00
$ 875.00
7.20
4" Conduit Bore
1725
LF
$ 35.00
$ 60,375.00
7.21
2" Conduit Bore
1070
LF
$ 33.00
$ 35,310.00
8.21
Final Set Sweeps at Pull Box and Transformers
19
EA
$ 500.00
$ 9,500.00
1.11
As Builts
1
LS
$ 1,500.00
$ 1,500.00
1.2
Payment and Performance Bond - Increase due to bonding
charge(s) at the end of the Phase I for change order increases
(No charge backs for Phase 1)
1
LS
$ 1,369.35
$ 1,369.35
6.22
CREDIT -Sanitary Bypass
3
EA
-$ 6,500.00
-$ 19,500.00
ADDT OF 21 DAYS TO CONTRACT
$ 118,804.35
SEWER STORM CONFLICT STA 3+30 STRUCTURE D232A $ 6,110.50
5.17
6' Conflict Manhole
1
EA
$ 3,500.00
$ 3,500.00
6.01
Remove and replace 6" sewer lateral
1
EA
$ 1,250.00
$ 1,250.00
6.33
6" Maxi adapter
2
EA
$ 250.00
$ 500.00
6.34
6" 401 Epoxy DIP
20
LF
$ 40.00
$ 800.00
1.2
Payment and Performance Bond - Increase due to bonding
charge(s) at the end of the Phase 1 for change order increases
(No charge backs for Phase I)
1
LS
$ 60.50
$ 60.50
ADDT OF 1 DAYS TO CONTRACT
$ 6,110.50
BECKER FUNERAL HOME REAR PARKING LOT TO 8TH ST DRAINAGE NO CHARGE
ISSUE
Installed HDPE at back of Beckers rear parking lot
along with structure to resolve drainage issue and excessive
run off onto 8th Street fAT NO CHARGE,
1
LS
$ -
$ -
NO CHARGE
CHANGE ORDER #1 TOTAL 124,914.850