Contract - Capital Excavation Company - 8/24/2017 1
Page I of 5
Contract Quantity Adjustment/Change Order
ROUND IOCK TEXAS
rev,06/15
Department: Transportation
Project
Name: Creek Bend Blvd Extension Date: 7/27/17
City Project Change Order/Quantity
ID Number ST33CBDR Adjustment No. 7
Justification
Quantity Adjustment/Change Order No. 7 is the final quantity adjustment to reflect actual project quantities for the project close out.These
quantity adjustments are the result of deductions found during the project's completion.This QA/CO#7 totals $365,763.80 in deductions.
SUMMARY Amount %Change
Original Contract Price: i
$8,089,168.50
Previous Quantity Adjustment(s): $169,356.49
This Quantity Adjustment: -$365,763.80
Total Quantity Adjustment(s): -$196,407.31
Total Contract Price with Quantity Adjustment(s): $7,892,761.19
Previous Change Order(s): $352,284.14 0.04
This Change Order: 0.00
Total Change Order(s)To Date:
$352,284.14 0.04
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $8,245,045.33
Difference between Original and Adjusted Contract Prices: $155,876.83
Original Contract Time: 435
Time Adjustment by previous Quan.Adj./Change Order: 140
Time Adjustment by this Quan.Adj./Change Order: 6
New Contract Time: 581
Prepared By: Randy Crum, Project Manager,City of Round Rock 7/27/17
Signature Printed Name,Title, Company Date
Approvals
Contractor: Logan Ginbey, Project Coordinaor,Capital Excavation Company 7/27/17
S' ature Printed Name,Title,Company Date
City Project
Manager: Randy Crum, Project Manager,City of Round Rock 7/27/17
Sign ure Printed Name,Title Date
Mayor/City //,��-�/� �n
Manager A / v'" �Y vt yi t5-4-7'�
Sign ure V Printed Wme,Title J Date
1
Page 2 of 5
Contract Quantity Adjustment/Change Order
ROUND ROCK TEXAS
rev,06/15
Project Name: Creek Bend Blvd Extension
Quan.Adj./Change Order No.: 7
Change Order Data
Contract
Time
Adjustment
Item # Item Description Unit Qty. Unit Price Amount (Days)
$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:J $0.00 0
Page 3 of 5
Contract Quantity Adjustment/Change Order
ROUND ROCK TEXAS
rev,06/15
Project Name: Creek Bend Blvd Extension
Quan.Adj./Change Order No.: 7
Quantity Adjustment Data
Contract
Time
Bid Item # Item Description Unit Qty. Unit Price Amount Adjustment
164-2034 Drill Seeding Perm Rural Clay SY -13,499.33 $0.20 -$2,699.87
164-2041 Drill Seeding Temp Warm ST -161004 $0.20 -$3,200.80
306-01 Prime Coat GAL -2467 $4.50 -$11,101.50
416-2007 Drill Shaft 54" LF -1.99 $300.00 -$597.00
416-2029 Drill Shaft RDWY ILL Pole 30" LF -12 $300.00 -$3,600.00
420-2001 Class A Conc Misc CY -51 $700.00 -$35,700.00
591-02 Riprap Stone Protection 24" D5012 CY -148 $200.00 -$29,600.00
510-01 RC Pipe CL III 18" LF -30 $70.00 -$2,100.00
620-2012 Electrical Condr#8 Insulated LF -630 $1.00 -$630.00
624-2008 Ground Box TY A 122311W/Apron EA -1 $1,000.00 -$1,000.00
624-2006 Ground Box TY 3 With Apron EA -1 $2,000.00 -$2,000.00
Electrical Svc TY A 240/480 060 NS AL E
628-2013 PS U EA -2 $6,000.00 -$12,000.00
644-2056 Reloc SM RD SN SUP/AM TY 10BWG EA -2 $400.00 -$800.00
861-02 Refl PAV MRK TY 1 W 8" DOT LF -28 $2.00 -$56.00
861-06 Refl PAV MRK TY 1 Y 8"SLD LF -251 $1.00 -$251.00
860-06 Refl PAV MRK TY 1 Y 4"SLD LF -46 $1.00 -$46.00
860-04 Refl PAV MRK TY II W 8" DOT LF -28 $7.00 -$196.00
860-07 Refl PAV MRK TY II W 12"SLD LF -82 $2.00 -$164.00
860-08 Refl PAV MRK TY II Y 8" SLD LF -251 $1.00 -$251.00
860-01 Refl PAV MRK TY II W 24" SLD LF -51 $4.00 -$204.00
860-02 Refl PAV MRK TY II Y 4"SLD LF -35 $0.30 -$10.50
874-01 Elim Ext PAV MRK&MRKS 4" LF -96 $1.00 -$96.00
874-02 Elim Ext PAV MRK&MRKS 8" LF -260 $2.00 -$520.00
874-03 Elim Ext PAV MRK&MRKS 12" LF -105 $3.00 -$315.00
1122-2002 Rock Filter Dam Install TY 2 LF -40 $20.00 -$800.00
1122-2009 Rock Filter Dam Remove LF -40 $9.00 -$360.00
Hot Mix Asphaltic Concrete Pavement TY
340-01 C TON -70.1 $80.00 -$5,608.00
Battery Backup System To Be Furnished
By The Contractor And Installed By the
510-27 City EA -1 $2,000.00 -$2,000.00
6834-2002 Portable Changeable Message Sign EA -1 $6,000.00 -$6,000.00
500-2001 Landscaping LS -1 $300,000.00 -$300,000.00
510-13 Wet Connections 8" DIA X 8" DIA EA -1 $4,000.00 -$4,000.00
510-18 12"Coupling EA -1 $600.00 -$600.00
510-19 8"Coupling EA -1 $400.00 -$400.00
Valves Resilient Wedge Gate Valve 16"
511-02 DIA EA -1 $8,000.00 -$8,000.00
Valves Resilient Wedge Gate Valve 10"
511-04 DIA EA -2 $3,000.00 -$6,000.00
511-08 Fire Hydrant EA -1 $5,000.001 -$5,000.00
Page 4 of 5
Contract Quantity Adjustment/Change Order
RDUND ROCK TEXAS
rev,06/15
Automatic Combination Air/Vacuum
511-09 Realease Valve Assm 2" EA -0.7 $2,000.00 -$1,400.00
511-10 Manual Air Realease Valve Assembly EA -2 $800.00 -$1,600.00
210-02 Flexible Base Subbase/Subgrade CY -5091 $30.00 -$152,730.00
510-17 16"coupling EA 1 $900.00 $900.00
505-02 20" Steel Encasement Pipe LF 52 $90.00 $4,680.00
636-2001 Aluminum Sign TY A SF 46 $40.00 $1,840.00
502-2001 Barricades Signs&Traffic Handling MO 6 $3,000.00 $18,000.00
1122-2048 Biogrd Erosion Cont Logs 12" Dia LF 11140 $4.00 $44,560.00
420-2049 CIL S Conc Bridge Median CY 9 $430.00 $3,870.00
104-02 Concrete Sidewalks&Driveways SF 166 $2.00 $332.00
618-2018 Condt PVC SCH 40 2" LF -30 $15.00 -$450.00
618-2019 Condt PVC SCH 40 2" Bore LF 110 $50.00 $5,500.00
1122-2016 Construction Entrance Install TY 1 SY 206.83 $10.00 $2,068.30
1122-2019 Construction Entrance Remove SY 206.83 $8.00 $1,654.64
Ec-01 Curb Inlet Protection EA 5 $80.00 $400.00
531-2006 Curb Ramps TY 2 EA 4 $1,400.00 $5,600.00
416-2004 Drill Shaft 36" LF 91.56 $170.00 $15,565.20
530-2011 Driveway ACP SY 45 $40.00 $1,800.00
874-04 Elem Ext Pav Mrk&Mrks Arrow EA 1 $80.00 $80.00
874-05 Elem Ext Pav Mrk&Mrks Word EA 2 $130.00 $260.00
401-2001 Flowable Backfill CY 37 $140.00 $5,180.00
644-2001 IN SM RD SN SUP/AM TY 10 BWG1 SAP EA 3 $400.00 $1,200.00
5085-3 Inlet Compl 10' EA 5 $6,000.00 $30,000.00
432S-01 New PC Concrete Sidewalk 5"Thicjness SF 474 $4.00 $1,896.00
430-01 PC Concrete Curb&Gutter Excavation LF 123 $12.00 $1,476.00
433-01 PC Concrete Driveway SF 717 $9.00 $6,453.00
Pipe 12" DIA PVC DR 14 C900 Incl
510-08 Excavation and Backfill LF 16 $60.00 $960.00
315-01 Plane&Text Asph Conc Pav 0-2" SY 8441 $3.00 $25,323.00
7000-1 Precast Concrete Fence LF 212 $70.00 $14,840.00
510-2 RC Pipe CL III 24" LF 29 $80.00 $2,320.00
510-05 RC Pipe CL III 42" LF 13 $170.00 $2,210.00
861-03 Refl Pav Mrk TY 1 W 8"Sid LF 915 $1.00 $915.00
861-4 Refl PAV MRK TY 1 W 12" LF 249 $3.00 $747.00
861-05 Refl Pav MRK TY 1 W 24" Sid LF -12 $6.00 -$72.00
861-01 REFL PAV MRK TY I W 4" BRK LF 1273 $1.00 $1,273.00
871-01 REFL PAV MRK TY I W ARROW EA 4 $90.00 $360.00
871-02 REFL PAV MRK TY I W WORD EA 1 $120.00 $120.00
860-03 REFL PAV MRK TY II W 4" BRK LF 677 $0.30 $203.10
860-05 REFL PAV MRK TY II W 8" SLD LF 944 $1.00 $944.00
871-04 REFL PAV MRK TY II W WORD EA 1 $90.00 $90.00
873-01 REFL PAV MRKR TY IICR EA 128 $7.00 $896.00
104-03 REMOVE PC CONCRETE CURB LF 215 $8.00 $1,720.00
644-2060 REMOVE SM RD SN SUP/AM EA 2 $100.00 $200.00
104-01 REMOVING PC CONCRETE SLAB SF -693 $6.00 -$4,158.00
REMOVING STAB BASE&ASPHALT
105-2014 PAVING 7"-12" SY 213 $7.00 $1,491.00
423-2006 RETAINING WALL CONC BLOCK SF 115.5 $40.00 $4,620.00
423-201 RETAINING WALL MSE SF 0.0046 $50.00 $0.23
432-2039 RIPRAP MOW STRIP 4" CY 8.2 $500.00 $4,100.00
591-01 RIPRAP STONE PROTECTION 12" D50=8" CY 29.7 1 $400.00 $11,880.00
Page 5 of 5
Contract Quantity Adjustment/Change Order
y..
ROUND ROCK!E xa',
rev,06/15
509-01 TRENCH PROTECTION LF 286 $2.00 $572.00
CO#2 VIBRATION MONITORING MO 3 $3,817.80 $11,453.40
$0.00
$0.00
$0.00
TOTALS: -$365,763.80 0
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-242193
Capital Excavation
BUDA,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 07/27/2017
being filed.
City of Round Rock Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
ST33CBDR
Construction of new roadway, bridge, utilities for Creek Bend Blvd. Final Closeout.
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
S ature of authori p agent of c racting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the saidV this the day of
20 ,to certify which,witness my hand and seal of office.
4o,►�YP�e� STACY TUCKER
NOTARY PUBLIC
FnQT .gr-rr-NW/A n
Signature of o icer administering oath Prin d f g� A'l i��� Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883
CERTIFICATE OF INTERESTED PARTIES FORM 1295
10f1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-242193
Capital Excavation
BUDA,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 07/27/2017
being filed.
City of Round Rock Date Acknowledged:
08/10/2017
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
ST33CBDR
Construction of new roadway, bridge, utilities for Creek Bend Blvd. Final Closeout.
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said this the day of
20 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883