Contract - Texas Materials - 6/13/2019Pagel of 3
T°Nop°«.ems Contract Quantity Adjustment/Change Order
Tpll—
rev, 03/16
Department:
Project
Name: 2017 SMP University Blvd Surface Treatment Date: 5/22/19
City Project Change Order/Quantity
ID Number Adjustment No. 2
Vendor Texas Materials 1320 Arrow Point Dr., Ste 600 512-571-6072
Company Name Address Phone No.
Justification
Stripping items needed and were not part of original contract.
Butt joints are needed to transition in the project without a bump and edgemili was needed to tie into curb and gutter section tha was added Into
the project.
SUMMARY
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
Pedro Alonso, Project Man
21
0
0
21
Texas Materials
Amount % Change
$0.00'
$58,285.50 i
$58,285.50
$4311785.50 ,
$46,815.01 11%
$0.00 0%
$46,815.01 11%
$105,100.51
Signature Printed Name, Title, Company Date
- - - -- — __-. �. - — - - ..?pravdll
Contractor Pedro Alonso, Proect Manager, Texas Materials 5 22/19
/ Signature Printed Name, Title, Company Date
City Project
0 !
Manager: a oi� mv1Ce�e a Ln :a1.CAr' /1ssicti-fie. t5 Z-Z•let
Sign re Printed Name, Title Date
Mayor/City
Managed �"l V�livW �#� �J, 9ViY�f/[ll ii�j • �?j l
Page 2 of 3
Contract Quantity Adjustment/Change Order
pOUNO pOCK'IEXA6
rev, 01/16
Project Name: 2017 SMP University Blvd Surface Treatment
Quan. Adj./Change Order No.
Chanap [briar data
nItemm
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
us s
$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
Asowl
0
Page 3 of 3
ROUNOROCKIE%,15 Contract Quantity Adjustment/Change Order
rev, 01116
Project Name: 2017 SMP University Blvd Surface Treatment
Quan. Adj./Change Order No.:
Quantity Adjustment Data
Bid Item #
Item Description
P
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
1
HMAC TY-D 1 1/2" Overlay
TON
747.25
$78.00
$58,285.50
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
$0.00
T AL :
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:
2019-499171
i Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Texas Materials Group, Inc
Cedar Park, TX United States
Date Filed:
06/03/2019
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
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 serviccte ,goods, or other property to be provided under the contract.
N/A Una �i/� O
s� t,,t
Surface Treatme , Asphalt, Mill and Overlay, Concrete Repair
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
CRH Americas Materials, Inc
Atlanta, GA United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is & W � G. L�Q�✓►� I' and my date of birth Is
�0 I �}
My address is `3j�Li t D�A4 bn gtot/( i /�Y , _L_, ,— "WA
(street) (city) (state) (zip code) (country)
declare under penalty that the foregoing is true and correct.
+perjury
-�
tit'
Executed in Q f ( (A yv1Soyi County, State of t�i)(ti S on the day of %tom 20J-1—.
()3— 0-,Ji (month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
t-urms provlaea uy i exas Links Lommssion www,etnics,stateums Version V1,1391`8039c
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:
12019-499171
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Texas Materials Group, Inc
Cedar Park, TX United States
Date Filed:
06/03/2019
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
Date Acknowledged:
06/12/2019
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.
N/A
Surface Treatment, Asphalt, Mill and Overlay, Concrete Repair
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
CRH Americas Materials, Inc
Atlanta , GA 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 V1.1.39f8039c