Contract - Cash Construction - 9/14/2017 r
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Page 1 of 3
Contract Quantity Adjustment/Change Order
ROINU ROCK,TE7Gl5
n..n.uiw4rnn i.t"eiwiriri
rev,08/12
Department: Transportation
Project
Name: CORR SWDT Ph 5B Date: 8/9/17
City Project Change Order/Quantity
ID Number SWDT5 Adjustment No. 1
Justification
Waterline service size upgrade(4"to 6"&6"to 8"),additional electric conduit needed, additional trench drain needed,and paving quantity added. Deducted
items removed because they are not going to be used in the contract. Waterline B conflict with existing utilities not show in plans. New storm drain items
added for additional drainage needs.
SUMMARY Amount %Change
Original Contract Price: $4,315,214.00
Previous Quantity Adjustment(s): $0.00
This Quantity Adjustment: $51,016.00 f
Total Quantity Adjustment(s): $51,016.00
Total Contract Price with Quantity Adjustment(s): $4,366,230.00
Previous Change Order(s): $0.00 0%
This Change Order: $43,825.00 1%
Total Change Order(s)To Date: $43,825.00 1%
Adjusted Contract Price [Original Contract Price Plus Quantity Adjustment(s)
Plus Change Order(s)]: $4,410,055.00
Difference between Original and Adjusted Contract Prices: $94,841.00
Original Contract Time: 360 Calendar Days
Time Adjustment by previous Quan.Adj./Change Order: 0 Calendar Days
Time Adjustment by this Quan.Adj./Change Order: 6 Calendar Days
New Contract Time: 366 Calendar Days
Submitted for Approval
Prepared By: B.J.Cash,Cash Construction �f
Sig ture Printed Name,Title,Company Date
Approvals
Contractor: B.J. Cash,Cash Construction
Signature Printed Name,Title,Company Date
City Project
Manager: Bill Stablein, Project Manager,CORR
Signature Printed Name,Title Date
Mayor/City M. Wyp
JManager y • t4
A/
Signature Printed Name,Title Date
��('+—A�—"I
Page 2 of 3
Contract Quantity Adjustment/Change Order
)�-
RQI IND RUCY:,T[XAS
rev,08/12
Project Name: CORR SWDT Ph 5B
Quan. Adj./Change Order No.: 1
Change Order Data
Contract
Time
Adjustment
Item# Item Description Unit 1 Qty. Unit Price Amount (Davs)
WL B Conflcit Station 3+44 to 4+20 LS 1 $15,545.00 $15,545.00 4
Time&Materials for Conduit Install Between Telecom
Manholes LS 1 $5,780.00 $5,780.00
8"Storm PVC LF 50 $100.00 $5,000.00 1
18"x 18"Grate Inlet EA 1 $1,000.00 $1,000.00 1
Gate Vavle, 6" Dia EA 11 $1,500.00 $16,500.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
K
• � L
Page 3 of 3
Contract Quantity Adjustment/Change Order
�RCN.!.Mn ROCK T[XAS
rev,08/12
Project Name: CORR SWDT Ph 5B
Quan. Adj./Change Order No.: 1
Quantity Adjustment Data
Contract
Time
Adjustment
Bid Item# Item Description Unit Qty. Unit Price Amount (Days)
Contract Adds
Pipe, 8" Dia. PVC AWWA C-900 Class 200,or DI AWWA
C-100 Min. Class 200 W(all depths), including
87 excavation and backfill LF 100 $90.00 $9,000.00
Pipe, 6" Dia. PVC AWWA C-900 Class 200, or DI AWWA
C-100 Min. Class 200 W(all depths), including
88 excavation and backfill LF 413 $85.00 $35,105.00
One to three each-3 inch or smaller service electrical
and/or communication conduits in one trench to
100 structure for service provider LF 345 $50.00 $17,250.00
50 Trench Drain per LF LF 9 $2,000.00 $18,000.00
96 Ductile Iron Fittings 4 inch through 12 inch Ton 1.25 $15,000.00 $18,750.00
Asphalt Stabilized Base: Hot Mix Asphaltic Concrete
Base(10.5"Thick),TXDOT Item 340,Type B(Black
37 Base) (Method A) under, and 1.5 feet behind roadway SY 759 $49.00 $37,191.00
$0.00
Contract Deducts $0.00
Pipe,4" Dia. PVC AWWA C-900 Class 200, or DI AWWA
C-100 Min. Class 200 W(all depths), including
89 excavation and backfill LF -413 $60.00 -$24,780.00
Pipe, 6" Dia. PVC AWWA C-900 Class 200,or DI AWWA
C-100 Min. Class 200 W(all depths), including
88 excavation and backfill LF -100 $85.00 -$8,500.00
Jacking or Boring 18"Steel Encasement Pipe,ASTM A-
97 252,Grade 2, including grouting LF -60 $550.00 -$33,000.00
Stabilized Construction Entrance, maintained thoughout
20-506-6020 project per each EA -2 $3,000.00 -$6,000.00
94 Gate Vavle,4" Dia EA -10 $1,200.00 -$12,000.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$51,016.00 0
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
lofl
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. 2017-247650
Cash Construction Company,Inc.
Pflugerville,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 08/09/2017
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.
SWDT5
Waterline service size upgrade(4"to 6"&6"to 8"),additional electric conduit needed,additional trench drain needed,and paving
quantity added. Deducted items removed because not using.
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Tintermediary
--F
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 and subscribed before me,by the said_ this the day of
20 ,to certify which,witness my hand and seal of office.
J �
04 4
nature of offic�administering oath Printed name of o 6cer administering oath 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 1.295
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. 2017-247650
Cash Construction Company, Inc.
Pflugerville,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 08/09/2017
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.
SWDT5
Waterline service size upgrade(4"to 6"&6"to 8"), additional electric conduit needed, additional trench drain needed, and paving
quantity added. Deducted items removed because not using.
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Tintermediary
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