Contract - Chasco Contractors - 7/26/2018 Page 1 of 3
Contract Quantity Adjustment/Change Order
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rev,08/12
Department: Transportation Department
Project
Name: McNeil Extension Phase 1 Date: 7/5/18
City Project Change Order/Quantity
ID Number RC1804-001 Adjustment No. 1
Justification
Ductbank sleeves, conduit for bore,and Overruns
SUMMARY Amount % Change
Original Contract Price: $1,744,147.00
Previous Quantity Adjustment(s): $0.00
This Quantity Adjustment: $4,000.00
Total Quantity Adjustment(s): $4,000.00
Total Contract Price with Quantity Adjustment(s): $1,748,147.00
Previous Change Order(s): $0.00 0.00
This Change Order: $89,902.00 0.05
Total Change Order(s)To Date: $89,902.00 0.05
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s) Plus Change Order(s)]: $1,838,049.00
Difference between Original and Adjusted Contract Prices: $93,902.00
Original Contract Time: 240
Time Adjustment by previous Quan.Adj./Change Order: 0
Time Adjustment by this Quan.Adj./Change Order: 25
New Contract Time: 265
Submitted for Approval
Prepared By: ` tLM•.�� Kellin Neiman, Sr. PM Chasco Constructors 7/5/18
Signature Printed Name,Title, Company Date
Approvals
Contractor: Kellin Neiman, Sr. PM Chasco Constructors 7/5/18
Signature Printed Name,Title,Company Date
City Project e---- /
Manager: eI14 ham✓ (I���
Signatu PrintedName,Title ate
Mayor/City
Manager cfzalomd"no Wqp— 00
Signat e Printed NAme,Title i Date
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Page 2 of 3
Contract Quantity Adjustment/Change Order
AROUND R(KK 7�CAS
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rev,08/12
Project Name: McNeil Extension Phase 1
Quan. Adj./Change Order No.: 1
Change Order Data
Contract
Time
Adjustment
Item # Item Description Unit Qty. Unit Price Amount (Days)
CP 001 Ductbank Sleeves LS 1 $88,382.00 $88,382.00 10
CP 002 Furnish 3" Conduit for Oncor Bore LS 1 $1,520.00 $1,520.00 0
$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: $89902.00 10
Page 3 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK TOCAS
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rev,08/12
Project Name: McNeil Extension Phase 1
Quan. Adj./Change Order No.: 1
Quantity Adjustment Data
Contract
Time
Adjustment
Bid Item # Item Description Unit Qty. Unit Price Amount
13281-1 EEMV&DISPOSE AC PIPE LF 76 $25.00 $1,900.00 0
30-508-1 4 x 4 Inlet EA 1 $2,100.00 $2,100.00 0
$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: $4,000.00 0
CERTIFICATE OF INTERESTED PARTIES
FORM 1.2951
10f1
t
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. 2018-377285
Chasco Constructors
Round Rock,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 07/09/2018
being filed.
The 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.
The City of Round Rock
Road Extension-McNeil 18011
4 Nature of interest +
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling-T Intermediary
Glace Jr.,Chuck Round Rock,TX United States X
King, Charles R. Round Rock,TX United States X
f
5 Check only if there is NO Interested Party. a
1?
6 UNSWORN DECLARATION
My name is Charles King , and my date of birth is 7-24-55
My address is 2801 E. Old Settlers Blvd Round Rock TX , 78665 USA
li
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in Williamson County, State of Texas 4 ,on the 9th day of July ,20 18 .
(month) (year)
Signature of auth&izeYagAnt of contracting business entity
(Dec l rant)
i
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
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. 2018-297842
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 01/02/2018
being filed.
City of Round Rock Date Acknowledged:
02/01/2018
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.
CORR SW Downtown 5B
Additional concrete items such as turndown rockwalls, sidewalk, steps and driveways added to project scope.Also,dumpster pads
and rock pedestals added.
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 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337