Contract - Corrosion Eliminators - 4/25/2019 Page I ol'3
Contract Quantity Adjustment/Change Order
ROUND ROCK
rev,01 16
Department: Utilities&Environmeental Services
Project
Name: Clearwell No.2 Rehab 2019 Date: 3/26/19
City Project Change Order/Quantity
ID Number CLRW2 Adjustment No. i
Vendor Corrosion Eliminators, LLC. 1002 Hwy. 337. Mineral Wells,TX. 76067 940-325-8450
Company Name Address Phone No.
Justification
Replacing 50 additional rafters and 88 additional knuckle supports
SUMMARY Amount %Change
_
Original Contract Price: F-�$501,480.0
Previous Quantity Adjustment(s):
This Quantity Adjustment: $74,060.00
Total Quantity Adjustment(s): $74,060.00
Total Contract Price with Quantity Adjustment(s): $575,540.00
Previous Change Order(s): 0%
This Change Order: $0.00 0%
Fatal Change Order(s)To Date: $0.00 0%
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $575,540.00
Difference between Original and Adjusted Contract Prices: $74,060.00
Original Contract Time: 150
Time Adjustment by previous Quan.Adj./Change Order:
Time Adjustment by this Quan.Adj./Change Order: 20
New Contract Time: 170
Prepared By: / Mark LeClair, President Corrosion Eliminators, LLC 3/27/19
Signature Printed Name,Title,Company Date
APgrovals
Contractor: Mark LeClair, President,Corrosion Eliminators, LLC 3/27/19
City Project
Signature Printed Name,Title,Company ate
jn
Manager: —: rte /r` *1.1 r
Printed Name,Title Date
Mayor/City q-
Manager f-ci (Atv cf t,rj t 4tz' 1 "Zr7'( _
Signatur Printed qame,Title Date
t.'/7 A(q, ��SD
Pape 2 of 3
Contract Quantity Adjustment/Change Order
*'-0"v—R0Cx 1
rev,01!16
Project Name: Clearwell No.2 Rehab 2019
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
$0.06
$0.00
$0.00
$0.00
$0.00
$0.00
$0.001
$0.00
$0.001
TOTALS:
Pau 3 ol'3
Contract Quantity Adjustment/Change Order
�r.aopc,
rev,01:16
Project Name: Clearwell No.2 Rehab 2019
Quan.Adj./Change Order No.: 1
Quantity Adjustment Data
Contract
Time
Bid Item # Item Description UnitAdjustment
Qty. Unit Price Amount
5 Rafters 1 50 $1,050.00 $52,500.00 15
6 Knuckle supports 1 88 $245.00 $21,56L).001 5
$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: $74,060.001 20
Page I of 3
�— Contract Quantity Adjustment/Change Order
ROUND ROM
Ll li?.
Department: Utilities&Environmeental Services
Project
Name: Clearwell No.2 Rehab 2019 Date: 3/26/19
City Project Change Order/Quantity
ID Number CLRW2 Adjustment No. 1
Vendor Corrosion Eliminators, LLC. 1002 Hwy. 337. Mineral Wells,TX. 76067 940-325-8450
Company Name Address Phone No.
Justification
Replacing 50 additional rafters and 88 additional knuckle supports
SUMMARY Amount %Change
Original Contract Price: $501,480.00
Previous Quantity Adjustment(s):
This Quantity Adjustment: $74,060.00,,
Total Quantity Adjustment(s): $74,060.00;
Total Contract Price with Quantity Adjustment(s): $575,540.00
Previous Change Order(s): polo
This Change Order: $0.00 0%
Total Change Order(s)To Date: $0.00 00/0
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $575,540.00
Difference between Original and Adjusted Contract Prices: $74,060.00
Original Contract Time: 150
Time Adjustment by previous Quan.Adj./Change Order:
Time Adjustment by this Quan.Adj./Change Order: 20
New Contract Time: 170
Pubm fitted for Approvall
Prepared By: Mark LeClair, President,Corrosion Eliminators, LLC 3/27/19
Signature Printed Name,Title, Company Date
Approvals
Contractor:
Mark LeClair, President,Corrosion Eliminators, LLC 3/27/19
City Project
Si ature Printed Name,Title, Company Date
]
Manager: -` 110
ignatur Printed Name,Title Date
Mayor/City
Manager
Signature Printed Name,Title Date
Page 2 of 3
nr\ Contract Quantity Adjustment/Change Order
ROUND Roca
ev.01 16
Project Name: Clearwell No.2 Rehab 2019
Quan.Adj./Change Order No.: 1
Chan a Order Data
Contract
Time
Adjustment
Item # Item Description Unit Qty. Unit Price Amount Adjusus(Das
$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
T T L
('age 3 of")
Contract Quantity Adjustment/Change Order
Y ROUND ROCK
C,
Project Name: Clearwell No.2 Rehab 2019
Quan.Adj./Change Order No.: 1
Quantity Adjustment Data
Contract
Time
Bid Item # Item Description UnitAdjustment
Qty. Unit Price Amount
5 Rafters 1 50 $1,050.00 $52,500.00 15
6 Knuckle supports 1 88245.00
$ $21,560.00 5
$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: .�
_ 74 060.00 20
CERTIFICATE OF INTERESTED. PARTIES FORM 1295
10fl
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. 2019-475650
Corrosion Eliminators,LLC
Mineral Wells,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 04/11/2019
being filed. D
City of Round Rock ate 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.
0000
Clearwell GST 2 Rehabilitation
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party. M
6 UNSWORN DECLARATION
My name is and my date of birth is
My address is I'0 P
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in (�o County, State of on the day of l,t ,20
(month) (year)
Signature of au d agent of contracting business entity
Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1,39f8039c
e
CERTIFICATE OF INTERESTED PARTIES
FORM1295
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. 2019-475650
Corrosion Eliminators, LLC
Mineral Wells,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 04/11/2019
being filed.
City of Round Rock Date Acknowledged:
04/11/2019
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.
0000
Clearwell GST 2 Rehabilitation
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling T 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 V1.1.39f8039c