Contract 2022-020A.02DocuSign Envelope ID: 9D5D5337-AE1 4-44CD-8D33-D5D92F1 D0459
CHANGE ORDER FORM
Contract / P.O. Number: 2019-55 Bid Number: 19-051
Change Order Number: 2 Change Order Date: June 30, 2022
Project Name: Streetscape Phase 3 Department: Public Services
Job Location: 4th Street Boat Ramp
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).
No Cost Additive Change Order: Add a 30 day extension to incorporate the work described in Amendment 4 for the
removal of the old boat ramp and associated structures within Lake Minneola at the old 4th Street Boat Ramp.
ITEM
AMOUNT
A.
ORIGINAL CONTRACT VALUE:
$ 7,796,937.40
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):
% 0.0%
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
% 0.0%
G.
NEW CONTRACT VALUE (A+E)
$ 7,796,937.40
This Change Order is not valid without the following signatures:
Ea
DocuSigned by:
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CONTRACTOR
DocuSigned by:
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6/30/2022
Date PROJECT ARCHITECT / ENGINEER
DS DocuSigned by:
6/30/2022� Eb15
8A394C8
Date
7/1/2022
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