Contract - Chasco Constructors - 5/23/2019Page 1 of 3
Contract Quantity Adjustment/ Change Order
rev, 01/16
Department: Transportation
Project
Name: Harrell Pkwy & Brushy Creek Plant Road Date: 4/15/19
City Project Change Order/Quantity
ID Number Adjustment No. 1
Vendor Chasco Constructors PO Box 1057, Round Rock, TX 78680 512-244-0600
Company Name Address Phone No.
]ustification
tevise 24" & 30" bores for Harrell Pkwy to be done from north to south due to UPRR restrictions
SUMMAKY
Original Contract Price:
Previous Quantity Adjustment(s):
This Quantity Adjustment:
Total Quantity Adjustment(s):
Total Contract Price with Quantity Adjustment(s):
Previous Change Order(s):
This Change Order:
Total Change Order(s) To Date:
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s) Plus Change Order(s)]:
Difference between Original and Adjusted Contract Prices:
Original Contract Time:
Time Adjustment by previous Quan. Adj./Change Order:
Time Adjustment by this Quan. Adj./Change Order:
New Contract Time:
Submitted for Approval
Prepared By:
242
0
20
262
Amount % Change
$3,549,994.40
$0.00
$0.00
$3,549,994.401
$0.00
$86,069.00
$86,069.00
$3,636,063.40
$86,069.00
0%
2%
2%
Signature
Printed Name, Title, Company
Date
Approvals
Contractor:k�lw
n
L.C. 1C,/ R. A*( e# -+S(:• )
lj/�.�5 ��
Signature
Printed Name, Title, Company
Date
City Project
Manager:
-(�
Signatur
Printed Name, Title
Date
Mayor/City
Manager
Contract Quantity Adjustment/Change Order
ROONO ROCK I L%A•:
MV, 01/16
Project Name: Harrell Pkwy & Brushy Creek Plant Road
Quan. Adj./Change Order No.
Chanae Order Data
Page 2 of 3
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
Adjusus s
1
Haul off bore pit spoil to staging area
HR
20
$200.00
$4,000.00
2
Rental fencing
MO
3
$1,000.00
$3,000.00
3
Tri dike
LF
100
$15.00
$1,500.00
4
Dumpster for spoils - drop of & pick up
EA
2
$150.00
$300.00
5
Dumster pulls to remove spoils (24" & 30"
EA
20
$300.00
$6,000.00
6
Additonal 46 LF of 30" bore
LF 1
46
$600.00
$27,600.00
7
Remove extra casing 20 LF (24" & 30")
Utility crew, welder, helper & truck
DAY
6
$3,900.00
$23,400.00
8
Haul spoils from staging area back to borE
HR
20
$200.00
$4,000.00
9
Backfill bore pits (density controlled)
Flex base, 2" HMAC paving, restripe pkg
SY
493
$33.00
$16,269.00
$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
Page 3 of 3
Contract Quantity Adjustment/Change Order
ROl1NO ROCK TkXA'�
rev, 01/16
Project Name: Harrell Pkwy & Brushy Creek Plant Road
Quan. Adj./Change Order No.
Ouantity Affbictmont nata
Bid Item # Item Description Unit
P Qty. Unit Price Amount
Contract
Time
Adjustment
$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
0.0
0
MCHASCO
CONSTRUCTORS
Harrell Pkwy
24" & 30" bores from Saltlick side
P.O. Box 1057
Round Rock, TX 78680
Tel: 512-244-0600
Toll free: 1-855-441-4109
Fax: 512-244-0489
mai l@chasco.coin
3/18/2019
Item
#
description
UOM
qty
unit price
subtotal
1
Haul off bore pit spoil to staging area
HR
20
$200.00
$4,000.00
2
Rental fencing
MO
3
$1,000.00
$3,000.00
3
Tri dike
LF
100
$15.00
$1,500.00
4
Dumpster for spoils - drop of & pick up
EA
2
$150.00
$300.00
5
Dumpster pulls to remove spoils (24" & 30")
EA
20
$300.00
$6,000.00
6
Additional 46 LF of 30" bore
LF
46
$600.00
$27,600.00
7
Remove extra casing 20 LF (24" & 30")
DAY
6
$3,900.00
$23,400.00
Utility crew, welder, helper & truck
8
Haul spoils from staging area back to bore pit
HR
20
$200.00
$4,000.00
9
Backfill bore pits (density controlled)
SY
493
$33.00
$16,269.00
Flex base, 2" HMAC paving, restripe pkg lot
total
$86,069.00
®I® AMERICAN SOCIETY
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CONCRETECONTRACTORS
ORS f
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1of1
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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2019-486239
Chasco Constructors
Round Rock, TX United States
Date Filed:
05/03/2019
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock, Texas
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.
CC 204-1-69
Harrell Pkwy Brushy Creek Road & Hwy 79 Improvements
4
Nature of interest
Name of Interested Party
City, State, Country (place of business)
(check applicable)
Controlling
Intermediary
King, Charles R
Round Rock, TX United States
X
Glace Jr., Chuck
Round Rock, TX United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is G and my date of birth Is
My address is TO 1� �j� f V
(street)cit
( y) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
/
T VCd
Executed in f I l I' or� County, State of on the r day of t 20�.
(mont (year)
Signature of authorized agent-4contracting business entity
(Declarant)
., I — t" —, ....__r -I ItI11-fulI www.cuucb.siaie,ix.us VersionV1.1.39f8039c
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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2019-486239
Chasco Constructors
Round Rock, TX United States
Date Filed:
05/03/2019
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock, Texas
Date Acknowledged:
05/23/2019
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.
CC 204-1-69
Harrell Pkwy Brushy Creek Road & Hwy 79 Improvements
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
King, Charles R
Round Rock, TX United States
X
Glace Jr., Chuck
Round Rock, TX United States
X
5 Check only if there is NO Interested Party. ❑
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 1 exas Ethics Commission www. ethics. state. tx.us Version V1.1.39f8039c