Contract - Central Road & Utility, Ltd. - 9/14/2017 b Page 1 of 3
Contract Quantity Adjustment/Change Order
rl--
ROCK rLXAS
rev,06/15
Department: Transportation
Project
Name: SWDT 411 Main St. Date: 5/30/17
City Project Change Order/Quantity
ID Number 411MN Adjustment No. 2
Justification
Quantity Adjustment/Change Order# 2 is required to add several unanticipated items to successfully complete the project.These items include
additional brick paver sidewalk,a larger reinforced concrete headwall at storm sewer outfall, removal of additional concrete sidewalk, installation
of new concrete sidewalk,addition of concrete steps to attach to existing 409 Main St. property,an additional ADA ramp,a dumpster enclosure
for the Baca Center, and additional concrete fill.Total for QA/CO# 2 is$89,350.99—11'C:16117 2�•W
SUMMARY Amount %Change
Original Contract Price: $491,165.00
Previous Quantity Adjustment(s): -$2,000.00
This Quantity Adjustment: $27,980.00
Total Quantity Adjustment(s): $25,980.00
Total Contract Price with Quantity Adjustment(s): $517,145.00
Previous Change Order(s): 0.02
$11,610.00
This Change Order: $67,250.00 0.13
Total Change Order(s)To Date: $78,860.00 0.15
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $596,005.00
Difference between Original and Adjusted Contract Prices: $104,840.00
Original Contract Time: 180 ( " [ Op6 DW6L uW "I U
Time Adjustment by previous Quan.Adj./Change Order: 1 q,cud �y
Time Adjustment by this Quan.Adj./Change Order: 58 0W,
New Contract Time: 239I( r#21)1/'
Submitted for Approval
Prepared By: Randy Crum, Project Manager,City of Round Rock 5/30/17
Signature Printed Name,Title, Company Date
Approvals
Contractor: (11• 6 e-� r ��! �� F/-71,,P-,u)7
Sign ,u a Printed Name,Title,Company Date
City Project � Q
Manager: Randy Crum, Project Manager, City of Round Rock 17
Signat Printed Name,Title Date
Mayor/City
Manager r� • l • (14-
Signal Printed N me,Title Date
Page 2 of 3
r
Contract Quantity Adjustment/Change Order
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UND ROCK TEXAS
rev,06/15
Project Name: SWDT 411 Main St.
Quan.Adj./Change Order No.: 2
Change Order Data
Contract
Time
Adjustment
Item # Item Description Unit Qty. Unit Price Amount Adjusus(Das
1 Dumpster Enclosure EA 1 $21,000.00 $21,000.00
2 Sidewalk Removal and Hauloff LF 40 $30.00 $1,200.00
3 Concrete Fill LF 30 $35.00 $1,050.00
4 Concrete Steps LS 1 $1,800.00 $1,800.00
5 Excavation &Grading LS 1 $1,500.00 $1,500.00
6 ADA Ramp EA 1 $1,300.00 $1,300.00
7 Ratainer Crub/Retaining Wall LF 160 $35.00 $5,600.00
8 5' Concrete Sidewalk LF 530 $10.00 $5,300.00
9 Concrete Headwall LS 1 $28,000.00 $28,000.00
10 Abandoned RCP Removal LF 10 $50.00 $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
R Page 3 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK TEXAS
rev,06/15
Project Name: SWDT 411 Main St.
Quan.Adj./Change Order No.: 2
Quantity Adjustment Data
Contract
Time
Bid Item # Item Description Unit Qty. Unit Price Amount Adjustment
17 Sidewalk Concrete Pavers SF 816 $10.00 $8,160.00
Additional 6'Sidewalk with Pavers
17 (Bagdad St.) SF 960 $10.00 $9,600.00
35 1.5" Sch 40 Irrigation Line LF 140 $50.00 $7,000.00
33 Grass Sodding SY 161 $20.00 $3,220.00
$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
$27,980.0010
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. 2017-244013
Central Road&Utility, Ltd.dba CRU, Ltd.
AUSTIN,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 08/01/2017
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.
411M N
SWDT 411 Main St.-Change Order#2
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I intermediary
George,Jay Austin,TX United States X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear,or affirm,under enalty of perjury,that the above disclosure is true and correct.
Sign tore of aut orintracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said C ,this the day of ,
20 ,to certify which,witness my hand and seal office.
Al. Z
nature of offic r dmmistering oath Printed name of officer administering oath Title oKfficer administerin ath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883
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. 2017-244013
Central Road&Utility, Ltd.dba CRU, Ltd.
AUSTIN,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 08/01/2017
being filed.
City of Round Rock Date Acknowledged:
08/14/2017
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.
411 M N
SWDT 411 Main St.-Change Order#2
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
George, Jay Austin,TX United States X
5 Check only if there is NO Interested Party. ❑
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