CM-2017-1431 - 7/7/2017�--
NO ROCK TEXAS
rc,., ,1/16
Department:
Project
Name:
City Project
ID Number
LCTNK
Contract Quantity Adjustment/Change Order
Utilities & Environmeental Services
Lake Creek GST Rehab 2016
Page I of 3
Date: 6/23/17
Change Order/Quantity
Adjustment No. 1
Vendor Tank Builders, Inc.
Company Name Address Phone No.
Justification
Tank Builders, Inc. added additional 1/4" carbon steel plate repads at the previous rafter to shell joints for extra corrosion protection, as directed
by the inspector. There were 30 repads in total added @ $50.00 each, for a total of $1,500.00
JV1.11•IwRi
Amount % Change
Original Contract Price:
$389,800.00
Previous Quantity Adjustment(s):
h
This Quantity Adjustment:
$0.00
Total Quantity Adjustment(s):
$0.00
Total Contract Price with Quantity Adjustment(s):
$389,800.00
IIII
CP ioP sous Change Order(s):
0%
Change Order:
$1,500.00 0%
Total Change Order(s) To Date:
$1,500.00 0%
Adjusted Contract Price [Original Contract Price Plus
QuantityAdjustment(s) Plus Change Order(Fs)]:
$391,300.00
Difference between Original and Adjusted Contract Prices:
$1,500.00
Original Contract Time:
120 Days
Time Adjustment by previous Quan. Adj./Change Order:
Time Adjustment by this Quan. Adj./Change Order:
New Contract Time:
120 Days
Submitted for Approval
Prepared By:
Kent Kromer, Vice President, Tank Builders, Inc.
6/23/17
Signature
Printed Name, Title, Company
Date
Approvals
Contractor:
Kent Kromer, Vice President, Tank Builders, Inc.
6/23/17
S' nature
Printed Name, Title, Company
Date
City Project
Manager:
Jeff Bell
P
ignatur
Printed Name, Title
.
Date
Mayor/City
( —7
Signature
0 Printed Name, Title
Date
Project Name: Lake Creek GST Rehab 2016
Quan. Adj./Change Order No.:
Chance Order Data
Page 2 of 3
Contract Quantity Adjustment/ Change Order
?OUNU ROCK TEXAS
Contract
Time
Adjustment
Adjusus(Das
Project Name: Lake Creek GST Rehab 2016
Quan. Adj./Change Order No.:
Chance Order Data
Page 2 of 3
Item # Item Description Unit Qty. Unit Price Amount
Contract
Time
Adjustment
Adjusus(Das
1 Interior Shell Repads EA 30 $50.00 $1,500.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS: $1,500.00
0
Contract Quantity Adjustment/ Change Order
A
IOUNO ROCK l L XA'.:
Project Name: Lake Creek GST Rehab 2016
Quan. Adj./Change Order No.
Onantity Arliiiatmant r)atm
Page 3 of 3
Contract
Time
Bid Item # Item Description Unit Qty. Unit Price Amount Adjustment
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS: 0.00 0
CONTRACTOR'S AFFIDAVIT OF Owner: [ ]
PAYMENT OF DEBTS AND CLAIMS Architect: [ ]
Engineer: [ ]
Contractor: [ X ]
Surety: [ ]
Other: [ ]
Owner: Architect's/Engineer's Project No.:
City of Round Rock
221 E. Main Street
Round Rock, TX 78664 Contract For:
Project: Contract Dated: 1/13/2017
Lake Creek Ground Storage Tank Rehabilitation 2016
STATE OF:
COUNTY OF:
The undersigned hereby certifies that, except as listed below, payment has been made in full and
all obligations have otherwise been satisfied for all materials and equipment furnished, for all work,
labor, and services performed, and for all known indebtedness and claims against the Contractor for
damages arising in any manner in connection with the performance of the Contract referenced above
or which the Owner or Owner's property might in any way be held responsible or encumbered.
EXCEPTIONS:
SUPPORTING DOCUMENTS ATTACHED HERETO:
1. Consent of Surety to Final Payment. Whenever Surety is
involved, Consent of Surety is required.
Indicate attachment:)( Yes No
The following supporting documents should be attached hereto
if required by the Owner:
1. Contractor's Release or Waiver of Liens,
conditional upon receipt of final payment.
2. Separate Releases or Waivers of Liens from Subcontractors
and material and equipment suppliers, to the extent
required by the Owner, accompanied by a list thereof.
3. Contractor's Affidavit of Release of Liens
Affidavit
CONTRACTOR:
Tank Builders, Inc.
3900 Tarrant Main
PO Box 1527
Euless, TX 76039-1527
BY:
Si ature of Authorized Representative
Kent Kromer, Vice President
Printed Name and Title
Subscribed and om to before me on
this date: U
Notary Public:7j1 '��(�� M0(
VVV rr'��I
My Commission Expires: • �'� - �O 19
CHERYL LYNN GARCIA
Notary Public, State of Texas Aug. 2001
;
CONSENT OF
Owner
❑
SURETY COMPANY
Architect
❑
TO FINAL PAYMENT
Contractor
EX
Surety ❑
Other ❑
Project: Lake Creek Ground Storage Tank
(name, address)
TO (Owner)
r The City of Round Rock, Texas Applicable Bond Number: 46BCSH00761
Contract For:
Tank Rehabilitation
L
Contractor: Tank Builders, Inc.
J
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,
the Hartford Fire Insurance Company, Surety Company,
On bond of Tank Builders, Inc., Contractor,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall
not relieve the Surety Company of any of its obligations to
The City of Round Rock, Texas, Owner
as set forth in the said Surety Company§ bond.
IN WITNESS WHEREOF,
The Surety Company has hereunto set its hand this 23 day of June 2017
Attest: Attorney -in -Fact Jack M. Davis
(Seal): / Title
Direct Inquiries/Claims to:
THE HARTFORD
BOND, T-12
POWER OF ATTORNEY HartfOne Haford Plaza
ord, ConnectcutOG155
Bond. Cie ims(a)theha rtford.com
call 888-266-3488 orfax 860-757-6835
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: BELL INSURANCE GROUP
_ Agency Code: 46-503840
Hartford Fire insurance Company, a corporation dui\ organized under the laws of the State of Connecticut
Hartford Casualty Insurance Company, a corporation duly organized under the lasts of the State of Indiana
Hartford Accident and Indemnity Company, a corporation dui} organized under the lasts of the State of Connecticut
Hartford Underwriters Insurance Company a corporation dull organized under the latus ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation dull organized under the lasts of the State of Indiana
Hartford Insurance Company of Illinois, a corporation dull organized under the lasts of the State of Illinois
Hartford Insurance Company of the Midwest, a corporation dull organized under Isle lasts of the State of Indiana
Hartford Insurance Company of the Southeast, a corporation dull organized under the latus of the State of Florida
having their home office in Hartford Connecticut (hereinafter collectively referred to as the 'Companies") do hereby make, constitute and appoint
Jack M. Davis
of Dallas, Texas,
its true and lawful Attorney -in -Fact to sign its name as surety(ies) only as delineated above by , and to execute, seal and acknowledge the
following bond, undertaking, contract or written instrument.
Bond No. 46BCSHOO761
Naming Tank Builders, Inc. as Principal
and City of Round Rack, Texas as Obligee
in the amount of See Bond Form(s) on behalf of Company in its business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have
caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
it'?L.�t . '1'p_'T_0, ,),n�- �t 1y.ID'�•
�
I
T9
�roA3- n•1�
John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President
STATE OF CONNECTICUT
))) ss. Hartford
COUNTY OF HARTFORD
On this 11th day of January, 2016, before me personally came M Ross Fisher, tome known, who being by me duly sworn, did depose
and say: that he resides in the County of Hartford, State of Connecticut, that he is the Senior Vice President of the Companies, the corporations
described in and which executed the above instrument: that he knows the seals of the said corporations, that the seals affixed to the said
instrument are such corporate seals, that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his
name thereto by like authority
�w ar
i �t�►t res -(a. rt�l,tc .
Nura M Sirank
Norah Public
CERTIFICATE hfi Commission Expire% Marc 1 11 7018
I, the undersigned, Assistant Vice President of the Companies DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of October 13, 2016.
Signed and sealed at the City of Hartford.
r 4 _
3 �+rr``� :'..cn.lruti'.: t,Q4 r ; 9 �� t�.��s• r;
�� a' * 'i'trrr nrt,r • ha1N► t�.t 19 74/♦i!'p. 1D7s11•' 1 T9
a �::._� �•• �•P . �•� • �'y`li halt' �•r•� :c#.
i /cl
Kevin Heckman, Assistant Vice President
CPna!1iln
City of Round Rock
ROUND ROCK
TEXAS Agenda Item Summary
Agenda Number:
Title: Consider executing Quanity Adjustment/Change Order No. 1 with Tank
Builders, Inc. for the Lake Creek Ground Storage Tank Rehabilitation
Project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 7/7/2017
Dept Director: Michael Thane, Director of Utilities & environmental Services
Cost: $1,500.00
Indexes: Self -Financed Water Construction
Attachments: LAF - Quantity Adjustment -Change Order #1 w- Tank Builders
(00381248xA08F8).pdf, CO No 1_LC GST Rehab_6.30.17.xls,
Contractors affidavit of payment of debts and claims -Tank Builders.pdf
Department: Utilities and Environmental Services
Text of Legislative File CM -2017-1431
Consider executing Quanity Adjustment/Change Order No. 1 with Tank Builders, Inc.
for the Lake Creek Ground Storage Tank Rehabilitation Project.
The City currently has three active ground -water wells and a Ground Storage Tank
(GST) located along Lake Creek just east of Mays Street. At this location, the Lake
Creek GST was erected and placed into service in the early 1970's. The GST has been
rehabilitated several times during its 44 years of service. On Jan. 13, 2017, the City
contracted with Tank Builders, Inc. to replace the roof on the GST. The tank shell was
generally in good condition; however, during removal of the tank roof, it became evident
that repairs needed to be made to the shell where the rafters interfaced with the shell.
A total of 30 repairs (pads) were added to the shell. Each pad cost $50 totaling
$1,500.00.
The Utility Staff requests the City Manager to approve Change Order No. 1 for $1,500
raising the total contract amount to $391,300.
Cost: $1,500
Source of Funds: Self -Financed Water Construction
City of Round Rock Page 1 Printed on 7/6/2017
Agenda Item Summary Continued (CM -2017.1431)
City of Round Rock Page 2 Printed on 71612017