Contract - Oldcastle Materials - 10/25/2018 Page I of 3
Contract Quantity Adjustment/Change Order
� ROUNO ROCKTE%AS
rev,01/16
Department: Transportation
Project 2017 SMP Project 1 -Type F Overlay (Subdivisions) 9/7/18
Name: Date:
City Project Change Order/Quantity 1
ID Number Adjustment No.
Vendor Oldcastle Materials 1320 Arrow Point Dr # 600 Cedar Park, TX 78613 512.346.3839
Company Name Address Phone No.
Justitication
QA/CO No. 1 in the amount of$266,273.13 is due to the addition and deletion of quantities within the project scope at the City's request. These quantity
adjustments include the extension of the project limits and the addition of 23 streets including HMAC overlay, edge milling, manhole adjustments,removal and
replacement of concrete driveways,and extension of contract time(90 days)and traffic control duration. Negative quantity adjustments were made for repairs
initially estimated,but not required,comprised of pavement repairs,surface milling, level up,valve can adjustments, removal and replacement of concrete curb
and gutter,sidewalk ramps,and valley gutters.
SUMMARY Amount %Change
Original Contract Price: $3,290,450.00
Previous Quantity Adjustment(s): $0.00'
This Quantity Adjustment: $266,273.13'''
Total Quantity Adjustment(s): $266,273.13'!,
Total Contract Price with Quantity Adjustment(s): $3,556,723.13
Previous Change Order(s): 0%
This Change Order: $0.00 0%
Total Change Order(s)To Date: $0.00 0%
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s) Plus Change Order(s)]: $3,556,723.13
Difference between Original and Adjusted Contract Prices: $266,273.13
Original Contract Time: 120
Time Adjustment by previous Quan.Adj./Change Order: 0
Time Adjustment by this Quan.Adj./Change Order: 90
New Contract Time: 210
_ Submitted for Approval
Prepared By:ALeah I Collier, CORR Chief Transportation Engineer /.Ie ho/b
Signaturev Printed Name,Title, Company Date
Approvals
Contractor: 4Lyr?/Z�
Signature Printed Name,Title, Company Date
City Project
Manager: Mike Ackerman,Transportation Superintendent fZs Zoi
ignatur Printed Name,Title Date
Mayor/City
Manager 00MAM
Signatur r V Printed Name,Title Date
Page 2 of 3
Contract Quantity Adjustment/Change Order
R�UNO ROCKleXAS
rev,01/16
Project Name: 2017 SMP Project 1 -Type F Overlay(Subdivisions)
Quan. Adj./Change Order No.: 1
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: $0.001 0
Page 3 of 3
Contract Quantity Adjustment/Change Order
RUUNU RUIX TEXAS
rev,01/16
Project Name: 2017 SMP Project 1 -Type F Overlay(Subdivisions)
Quan.Adj./Change Order No.: 1
Quantity Adjustment Data
Contract
Time
Bid Item # Item Description Unit Qty. Unit Price Amount Adjustment
1 Type F HMAC 1" Overlay(23 streets) Ton 6,767.48 $75.00 $507,561.00
2 Pavement Repair Ton -3,465.30 $89.00 -$308,411.70
3 Edge Milling (6'wide)(23 streets) SY 44,886.80 $1.50 $67,330.20
4 Surface Milling SY -4,212.00 $1.70 -$7,160.40
5 Type D HMAC Spot Level Up Ton -100.00 $99.00 -$9,900.00
6 Valve Can Adjustment EA -107.00 $70.00 -$7,490.07
7 Manhole Adjustment EA 91.00 $300.00 $27,299.10
8 R&R Conc C&G LF -297.00 $42.00 -$12,474.00
9 R&R Reinf Conc Driveway SF 2,374.00 $10.00 $23,740.00
10 R&R Reinf Conc Sidewalk SF -2,872.00 $8.00 -$22,976.00
11 Reinf Conc Sidewalk Ramp EA -10.00 $1,500.00 -$15,000.00
12 R&R Reinf Conc Vlly Gttr SF -7.00 $35.00 -$245.00
13 Traffic Control MO 3.00 $8,000.00 $24,000.00 90
$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: 2 27 .
CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
101`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 Ceitificate Number:
of business. 2018-416720
Oldcaste Materials Texas,Inc
Cedar Park,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 10/19/2018
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 tite contract.
000000
City of Round Rock Overlay Change Order
4 Nature of interest
Name of Interested Parry City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Oldcastle TX United States X
5 Check only if there is NO Interested Party. O
6 UNSWORN DECLARATION
�
My name is�1Lra',�1�.( j] ,{,t fi t !,, {1 and my date of birth is IaW f�
My address is � 20 hgW�3"fylr. *'wo Gct tLu YrrU�/
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in W I MOLM56h County, State of 1�S on the day ofd ey-,20
(month) (year)
�J Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission vwwd.ethics.state.tx.us Version V1.0.6711
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. 2018-416720
Oldcaste Materials Texas, Inc
Cedar Park,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 10/19/2018
being filed.
City of Round Rock Date Acknowledged:
10/23/2018
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.
000000
City of Round Rock Overlay Change Order
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Oldcastle TX United States X
5 Check only if there is NO Interested Parry. ❑
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 V1.0.6711