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CM-2019-0344 - 11/1/2019Page l of 3 _ Contract Quantity Adjustment/Change Order ! ROUNCRDCX rev. Gt 16 Department: Transportation Project Name: Harrell Pkavy & Brush Creek Plant Road Date: 20/21/19 City Project Change Order/Quantity FD Number Adjustment No. Vendor Chasco Constructors PO Box 1057, Round Rock, TX 78680 512-244-0600 Company Name Address Phone No. Justification l) Railpros invoices for flagger at Harreil Pkwy intersection SUMMARY Amount % Change 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) Pius Change Order(s)j: 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 Co-itract Time: Signature Submitted for Approval Printed Name, Title, Company $3,544,994.40 $0.00 $0.00 $3,549,994.40 $186,436.00 $34,562.00 $220.998.00 1 $3,770,992.40 242 20 30 292 $220,998.00 Date 5% Approvals Contractor: ILL c r� 7�v d — 2 —I Signature Printed Name, Title, Co pang Date Manager:City Project nature f Printed Name, Tide + DJ ateMayor/CJ Managerry;�-wI i �j.i441 Project Name: Harrell Pkwy & Brushy Creek Plant Road Contract Quantity Adjustment/Change Order eeossraQ �cx r .07 1° Quan. Adj./Change Order No. Chance Order Data Page 2 of 3 Project Name: Harrell Pkwy & Brushy Creek Plant Road Item # Item Description Unit Qty. Unit Price Amount Contract 1 Raifpros Inv. #CC150161908 LS 1 $2,854.00 $2,854.00 2 i pros In, # 1 1 1 $31,708 $31,769.00 2b $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $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: $34,562.00 30 Project Name: Harrell Pkwy & Brushy Creek Plant Road Contract Quantity Adjustment/Change Order r ieourat P=K i Quan. Adj./Change Order No.: ftn*lf— AA4tica ant n=+2 Page 3 of 3 Bid Item # Item Description Unit Qty. Unit Price Amount Contract $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 TOTeLS!l cn nni n IAILPRas 0-7 else r-3 :,Er—%VICF--S I dV IV 09106: 201 u CCI 50161908 INVOICE RailPros invoice # CC150161908 Invoke Date 09/0612019 RP Task Order No_ 15016 PO# Terms Due on Receipt Location Period Roundrock, TX Services through 8131/2019 Description SERVICES PROVIDED TO; Chasco Constructors PO Box 1057 Round Rock, TX 78680 Quantity I Rate I Amount RWIC Seiler, Stanley Regular (Days) 2 998.00 1,996.00 Regular Overtime (Hours) 6.51 132.001 B58.00 PLEASE PAY THIS AMOUNT >> Balance Due 2,854.00 Please remit payment to, RallPros Field Services, Inc. 1320 Greenway Drive, Suite 490 Irving, TX 75038 Phone: 682-223-6897 Fax: 866-762-7619 Email: accounting.fs@railpros.com Aging Summary Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120 CC150161908 09/0612019 2.854.00 2.854.00 Total 2,86400 2,854.00 0.00 0.00 000 0 0cr Request for Taxpayer Give Form to the °�' g Identification Number and Certification requester. Do not (Rev, October x1318) send to the IRS. 17epadmRevenue Service erd of the Treasury � Go to www.irs.gov/FormW9 for Instructions and the latest Information. internal I Name (as shown on your income tax return;.. Name is required on this line; do not leave this line blank. RallPros Field Services, Inc. 2 Business name/disregarded entity naTe, it different from above dba Roadway Worker Training, Focal Point, Railroad Protective Services M 3 Check appropriate box for federal tax classiftation of the person whose name is entered on line 1 Check only one of the 4 i=xemptii3 (codes apply only to followin seven boxes. certain entities, not individuals: see las 9 instructions on page 3): CL p ❑ IndividuaVsole proprietor or 0 C Corporation ❑ S Corpore"'n ❑Partnership Trust/estate a single -member LLC Exempt payee code (if any) c1 ❑ Limited liability company. Enter the tax classification (C=C corporation. 5-S corporation, P=Partnership) Ili - Note: Rote: Check the appropriate box im t^e line above for the tax classification of the single member owner. Do not cher Exemption from FAG repo it+g p LLC it the LLC is classified as a sing'e-member LLC that is disregarded from the owner unless the Durran at the LLC is code (it any) another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single member LLC that a o is disregarded from the owner should check the appropriate box for the tax dassificalion of its owner. Vu ❑ Other (see instructions} 1 (A. -Via ro+ccom+e muuJ.�a atLcf rrr u CCL 5 Address (number, street, and apt. or suite noi See Instructions. Requester's nacre and address (optional) 4 1320 Greenway Drive, Suite 490 6 City, state, and ZIP code Irving, TX 75038 7 List account numbers) here (optionaf) • Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line i to avoid social security number backup withholding.For individuals, this is generally your social security number (SSN). However, fora resident alienen,,solesole proprietor, or disregarded entity, see the instntctons for Part 1, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see Now to get a TIN, later. or Note: It the account is In more than one name, ses the instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requester for guidelines cn whos= number to enter. 761 - 3 1 6 1 6 1 1 5 1 2 1 0 Under penalties of perjury, I certify that: 1. The number shown an this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me): and 2.1 am not subject to backup withholding because: (a)1 am exempt from backup withholding, or (b; I have not been notified by the internal Revenue Service (IRS) that I am subject to backup withholding as a resu°.t of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S, citizen or other U.S. person (defined below); and d. The FATCA code(s) entered on this form (if any) indicating that i am exempt from FATCA reportlrg is correct. Certification instructions. You must cross out item 2 above if you have been notified by the iRS that you are currentty subject to backup withh6cling because you have failed to report al,'Interest and dividen o ur tax retum. For real estate transactions, item 2 does not apply. For mortgage :nterest� �Y acquisition or abandonment of secured pro rty, collation of debt, contribut'ons to an individual retirement arrangement (1RA), and general! meats other than interest and dividends, you arta not r iced to sign th,p cert.,fcation. but you must prov'de your cor%ci TIN. See the ins'-uctons for Part Il, later Sign Signature of Mere I US. person ► General Instru Section references are to the internal Revenue Code unless otherwise noted. Future developments. For the West information about developments related to Form W-9 and its instructions, such as legislation enacted atter they were published, gr� to www,irs.gov/F`ormVV9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) wh'ch may be your social security number (SSN), individual taxpayer identification number (iT1N), adoption taxpayer identification number (ATIN), or employer identification number (E1N), to report on an information return the amount paid to you, or other amount reponable on an information return. Examples of information returns Include, but are not limited to, the foltowing. • Form 1099-iNT (interest earned or paid) Date ► 1/G // rf_ • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1 G99 -A (acquisition or abandonment of secured property) Use Form W-9 only tf you are a U.S. person (iicluding a resident alien), to provide your correct TIN if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What -s backup withholding.. later, Cat. No. 10231X Fort ilii -9 (Rev. 10-2018) F717 FIELD SERVICES Railroad: Date: 08/28/2019 Project Location: Roundrock, TX Client: Chasco Constructors LIPRR WO#: 069.4-84 Network/SO#: RPFS Job #: 15016 Daily Mileage 37 Subdivision: Austin MP Location: MP 158.25 Status of Job: On -Going Type of Protection: Form B To+i Free 877.315.0513 Fax 866.762.7619 1765 W Northwest Hwy, Ste 150 Grapevine, TX 76051 www.raiiprosfs.com RWIC DAILY WORK REPORT RWIC Name: SEILER, STANLEY Office Phone: 512-244-0600 RWIC Start Time 16:3Q RWIC End Time 07:00 Total Hours 14.50 Per Diem No CLC Yes Track Supervisor: Kamron Smith DOT Crossing: 439682d Description of Work and Daily Itinerary Notes: 16,09, Form 8 # 95167 Ok at 16.09 Dispatcher T80 16:37 At job site filling out all paperwork f_,r the day/downloading bulletins 1645. Test radios, job briefing with Tony Choi 17.10. 1st y,,l flag up mp 160.25 17,40. 2nd y/r flag up at mp 155.75 18.08. Amtk 163 18:08 south First train for the day 18:12. 1st red flag up at mp 158.25 18 18. 2nd red flag up at mp 157 75 18:20 Job briefing with 7 Chasco employees 18:30 Cl-.asco working digg,ng out road !9,09. Up 5491 north 20.00. Finished d'gging first part out ,level Ing to subgrade 20:20. BNSF 527 south 2100 Set 4 boxes in 21.16 Up 4919 north 1 al of 8 so far Date: 08/28/2019 RWIC Signature:t�-r 3ispatcher STB Client Signature: 0f5r>. f4t L.-aZ).og In Date: 08/28/2019 Client Name: RaMi`i Jae boxes going in Client Number: 5 2849 it t1i Wo=rnt:i fill voids Around boxes 'Every section must be completely fifleUL64DO y {signature REQUIRED, NO EXCEPTIONS, Submit completed MRS vi@mR IktMdMlrIR&qftdi*4Wm or via fax (866)762-7619 01.36. Up 7834 01:39 Digging the rest of the road aut,add ng gra-. el to =ill voi%ay Classification: Billable Day 01:55 Concrete truck on site 0220. Up 4519 north 02:33.2 more boxes going In 02.;40.2 more boxes going In 03.00 Working on subgrade r" Toll Free 877, 315.0513 :.�M Pau L PROS Fax Hwy, to 619 150 1705 W Northwest Hwy, Ste 150 1= 1 E L M S E R V I C E S Grapevine, Tx 76051 www.railprosfs.com Railroad: RWIC DAILY WORK REPORT Project Date: 08/30/2019 RWIC Name: 5EILER, STANLEY Project Location: Roundrock, TX Client: Chasco Constructors Office Phone: 512-244-0600 UPRR WO#: 0694-84 RWIC Start Time 05:30 Network/50#: RWIC End Time 13:00 RPFS Job M 15016 _ Total Flours 7.50 Daily Mileage 7 Per Diem No CLC Yes Work Zone Information Subdivision: Austin Track Supervisor. Kamron Smith MP Location: Mp 157.75 DOT Crossing: 439682d Status of Job: On -Going Type of Protection: Form 8 Description of Work and Daily Itinerary ! Notes: 0530 Fdling out all paperwork for the day,test radius 05:41 Form 8 verified disp STB,downloaded bulletins 06:00. 1st r/y flag up 06;26. 2nd y/r flag up 07:00.1st red flag up 07.05. 2nd red flag up 07.10. Job briefing with 7 Chasco employees 07:15 Chasco Constructors working 07.20. Digging to grade for last 20' of box culvert 07:40. BNSF 4497 north 08.00. Setting grade for bottom of box culverts 0&04. Lip 7999 north 08 10. 4 box culverts going in 08:55. Last 2 boxes going in 0910. Filling in gaps with rock RWIC Signature: 1° S`ire gett ng a b 8ger Date• 08/30/2019 LJ��� me t�-6i1�r ri rtc h Client Signature: - Date., 08/30/2019 Client Name: Able 4:1%64V 5457 north Client Number: -tiown at mp . efgvin at+up i5e.6- 12n27. 1st y/r flag down at mp 160.25 `Every section must be compleiOiy4€i!2 OOy/rg6k&Rii;f9i�4 PHftre REQL!lRED. NO EXCEPT1t3Ns. Submit completed MR91gAgm" dlrG4&M4l;lMArA0M or via fax (866)762-7619 Day Classification: Billable Day RaLPRos I_IL i Cl -17;ERV 10f 10/10/2019 CC150161909 INVOICE RaiiPros Invoice # CC150161909 invo ce Date 1011012019 RP Task Order No. 15016 PO# Terms Due on Receipt Location Period Description RWIC Lopez, Samuel Sr. Regular (Days) ar Overtime (Flours) SERVICES PROVIDED TO: Chasco Constructors PO Box 1057 Round Rock, TX 78680 Quantity f Rate I Amount 201 998-001 191960.00 891 132.001 11,748.00 PLEASE PA" THIS AMOUNT — Balance Due 31,708.00 Please remit payment to: RailPros Field Services, Inc. 1320 Greenway Drive, Suite 490 Irving, TX 75038 Phone: 682-223-6897 Fax: 866-762-7619 Email: accounting.fs@railpros.com Aging Summary Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120 CC150161909 10/10/2019 31 708 00 31,708.00 Total 31.708 00 31 708.00 000 0.00 000 000 Request for Taxpayer Give Form to the Form �, 9 identification Number and Certification requester. Do not (Flew_ October he T send to the IRS. I]eprrVI'v n the Service Irstemal Revenue Service ► Go to www.irs.govlFormW9for Instructions and lite latest informat2w,7ion. I Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. RaifPros Field Services, Inc. 2 Bus.ness name disregarded entity name, it different from above dba Roadway Worker Training, Focal Point, Railroad Protective Services r7 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 E:temptions (codes apply only to foi;owing seven boxes. certain entities not individuals see m instructions on page 3) CL is ❑ 1.,--dlvlduaVsole proprietor or (D C Corporat on ❑ S Corporation ❑ Partnership Trust/estate w rn single -member LLC Exempt payee code (f any) ❑ Lim.ted ,lobi;.ty. company. Enter the tax classification (C=C corporation, 5=S corporation, P=Partnership) ► `p Note: Check the appropriate box in the line above for t^.e tax classification of the single -member owner Do not check Exemption from FATCA reporting V1 LLC I! the .LC s classilied as a single -member LLC that Is disregarded from the owner unless the owner of the LLC is code (f any) S 5 another LLC that is not disregarded from the owner for U,S, federal tax purposes. Otherwise, a singte-member LLC that n u s disregarded frc in the owner should check the appropriate box for the tax classification of Hs owner. m C]Other (see instructions, 1,rrop r: ro acc+smb rrirn' x e o rsw m u.s, CL 5 Address (number, street, and apt. or suite no.) See instructions Requester's name and address (optional) a irT 1320 Greenway Drive, Suite 490 _j'C ty, state, and ZIP code Irving, TX 75038 7 Last rrccount numbers} here (optionai, WW .Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For Individuals, this is generally your social security number (SSM). However, for a_m - resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your emp'oyer iderilification number (EIN). If you do no, have a number, see How to get a TIN, later, Dr Note: If the account is In mor=_ than one name, see the instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. F2T61 _13 6 1 b 1 1 1 5 1 2 1 0 Under penalties of perjury. I certify that 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me) and 2.1 aril not subject to backup withholding because: (a) l am exempt from backup withholding, or (b) i have not been not fled by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup tv,thhoMing; and 3. 1 am a U_5. citizen or other U.S. person (defined belovil. and 4. The FATCA code(s) entered on this form (f any) indicating that I am exempt from FATCA reporting is correct. Certification Instnictlons. You r-.Lst cross out item 2 above it you have been notified by the IRS that You are currently subject to backup w thholding beca.!se you have failed to report all interest and d:viden o ur tax return. For real estate transactions, item 2 does not apply For mortgage .nterest pa d. acquisition or abandonme-,t of secured pro rty, ceNat,o-r of debt, contributions to an individual retirement arrangement ORA). and generally, payments other than in-erest and dividends, you ainot r ifed to s gn thpcertification, but you must provide your correct TIN. See the instructons for Part I tater, atgftI Signature of Here u,s. person ► General Instruc Ions Section references are to the Intemal Revene Code unless otherwise noted. Future developments. For the ;atest information about developments related to Form W-9 and its instructions, s.-ich as legislaton enacted after they were pub'°Shed_ go to www 1r5,gr.-vfForm[N9. Purpose of Form An Individual or entity (Form W-9 requester', who Is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security numbe• (SSM, Individual taxpayer identification number ([TIN) adoption taxpayer identification number (ATIN), or employer ident-ftcation number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information retums include, but are not limned to, the fcllowf.,g. • Form 1099 -INT (interest eamed or paid) Date 1W • Form 1 D99 -01V (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B istock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) ■ Form 1099-K (merchant card and third party network transact -ons) • Form 1098 (home mortgage Interest), 1098-E (studert loan interest'.. 1098-T (tuftfon) • Form 1099-C (canceled debt) • Forir 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S, person (Including a resident alien), to provide your correct TIN, It you do not return Form w -s to the requester with a TIN, You might be subject to backup Noithholding. See Vvhat is backup withholding. later. Cat W. 10231X Form W-9 (Rev 10.20181 City of Round Rock ROUND ROCK Agenda Item Summary Agenda Number: Title: Consider executing Quantity Adjustment/Changer Order No. 3 with Chasco Constructors for the Harrell Parkway and Brushy Creek Plant Road Project. Type: City Manager Item Governing Body: City Manager Approval Agenda Date: 11/1/2019 Dept Director: Gary Hudder, Transportation Director Cost: $34,562.00 Indexes: RR Transportation and Economic Development Corporation (Type B) Attachments: QA -CO #3 with Chasco - Harrell Pkwy & Brushy Creek Plant Rd Department: Transportation Department Text of Legislative File CM -2099-0344 This Change order # 3 is for the third party inspection required by Union Pacific Rail Road when doing work in their ROW. The Harrell Parkway and Brushy Creek Road are being constructed by Chasco Constructors and the approach to the roadway crosses the Union Pacific Rail Road tracks therefore requiring RaiiPros Field Services, Inc. The amount of this change order is $34,562.00. Cost: $34,562.00 Source of Funds: RR Transportation and Economic Development Corporation (Type B) City of Round Rock Page i Printed on 10/31/2019