Contract 2022-020A.01DocuSign Envelope ID: 4FC1 1 E7B-7741-49C3-B208-27D998E3FEBD
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 / 2022-0185 Bid Number: 19-051
Change Order Number: 1 Change Order Date: Jun 8, 2022
Project Name: Streetscape Phase 3 Department: Public Services
Job Location: 7th Street from Minneola to the City Hall Entrance Drive.
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).
Additive Change Order: Street Lights on West Minneola Ave.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 7,757,916.31
B.
AMOUNT OF THIS CHANGE ORDER:
$ 39,021.09
Must be within the overall scope of services in accordance with contract specifications.
C.
PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B/A):
% 0.5%
D.
AMOUNT OF PREVIOUS CHANGE ORDERS:
$ 0.00
E.
TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D):
$ 39,021.09
F.
PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 10% Maximum
% 0.5%
G.
NEW CONTRACT VALUE (A+E)
$ 7,796,937.40
This Change Order is not valid without the following signatures:
IDocuSigned by:
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CONTRACTOR Date PROJECT ARCHITECT / ENGINEER Date
DocuSigned by: DS DocuSigned by:
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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:
MAYOR Date CITY CLERK Date
Rev. 1-1-2021
DocuSign Envelope ID: 4FC1 1 E7B-7741-49C3-B208-27D998E3FEBD
•
Street Lights on West Minneola Ave (West to Victory) $ 39,021.09
Stake and Layout
1
LS
$ 1,300.00
$ 1,300.00
1" Conduit
240
LF
$ 25.00
$ 6,000.00
1.25" Conduit
500
LF
$ 25.00
$ 12,500.00
Install 3 Owner Furnishd Type A Light Fixtures
1
LS
$ 18,834.74
$ 18,834.74
1.2
Payment and Performance Bond - Increase due to additiional
bonding charge(s) 2%
1
LS
$ 386.35
$ 386.35
$ 39,021.09