Contract - ProDirt Services, LLC - 11/14/2019 Pagel of 3
Contract Quantity Adjustment/Change Order
ROUN[2ROCKTEXAS
rev,01j16
Department: Transportation
Project
Name: North Red Bud Turn Lane Date: 10/20/19
City Project Change Order/Quantity
ID Number Adjustment No.
Vendor Pr_o_Dirt Services,LLC P.O. Box 59,Georgetown,Tx 78627 (512)963-0313
Company Name Address Phone No.
Justification
Asphalt Overruns/Full Depth Repairs
SUMMARY Amount %Change
Fix
Original Contract Price:
9 s676,837.30
Previous Quantity Adjustment(s): $161,425.00 '' f ;
This Quantity Adjustment: $71,357.00 •
Total Quantity Adjustment(s): $2321782.00
Total Contract Price with Quantity Adjustment(s):
Previous Change Order(s): $37,615.00 4%
This Change Order: $0.00 00/0
Total Change Order(s)To Date: $37,615.00 4%
Adjusted Contract Price (Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $947,234.30
Difference between Original and Adjusted Contract Prices: $270,397.00
Original Contract Time: 120
Time Adjustment by previous Quan.Adj./Change Order: 0
Time Adjustment by this Quan.Adj./Change Order:
i
New Contract Time: 120
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Prepared By:
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Signature Printed Name,Title,Company Date
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Contractor: -
Signature Printed Name,Title,Company Date
City Project
Manager: 6 �n.eer �tss+e�e+►�e. `�' lZ• la
S' n t Printed Name,T' e Date
ity
MC )r—
n - Il t,ayor/Manager
Signature Printed Name,Title Date
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Page 2 of 3
!ROCKTE;(AS Contract Quantity Adjustment/Change Order
aau
rev,01/15
Project Name: North Red Bud Turn Lane
Quan.Adj./Change Order No.: 2
Change Order Data
5
Contract
Time
Item# Item Description Unit Qty- Unit Price Amount Adjustment
(Days)
$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
$0.001
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
F- $0.0()
0.00,
$0.00
$0.00
$0.00
777777,,
TOTALS:l $0.001
Page 3 of 3
Contract Quantity Adjustment/Change Order
rev,01/16
Project Name: North Red Bud Turn Lane
Quan.Adj./Change Order No.: 2
Quantity Adjustment Data
51
J.
Contract
Time
Bid Item # Item Description Unit Qty. Unit Price Amount Adjustment
Y'-
$0.00
10 Hot Mix Asphaltic Concrete,TY C TON 33 $120.00 5401200.00
25 Thermoplastic(Ty I XW)(SL D)(4")(090 MJJL) LF 1276 $3.50 -$4,466.00
$0.00
27 Thermoplastic(TY1 XY)(DBLX4'X090M1L) LF 270 $35.00 $9,450.00
28 The rmoplaslic(TY1)(Y)(SLD)(4"Y090MIL) LF 2474 $4.00 $9,896,00
29 Tner-T-op1asflc(TY1)(WXSLDX 1 2"XO90MIL) LF 27 $10.00 $270.00
31 Thermoplastic(Arrow)(TY1)(WXSLDX090M1L) EA $0.00
2 $150.00 $300.00
32 The rmop1asJc(W0RD)(TY1)(W YS LD1,(090M1 L) EA
2 $200.00 $400.00
6 Revegetation(Black Sodding) SY 850 $7.50 $6,375.00
$0.()0
S-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 fi
TOTALS:J $71,357.00 0
CERTIFICATE ' F INTERESTED PARTIES FORM 1295
1of1
Complete Nos.1-4 and 6 f there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3;5,aid 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity cling form,and the city,state and country of the business entity's place Certificate Number;
of business. 2019-557048
ProDirt Services,LLC
Hutto,TX United States, Date Filed:
Z Name of government e t ty or state agency that Is a party to the contract for which the form is 10130!2019
being filed.
Date Acknowledged:
City of Round Rock
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
Roadwork
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Dill,Tony Hutto,TX United States X
i
{
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I
I
i
i
I
3
i
f
3�
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ii
1
5 Check only if there is No Interested Party.
El
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. �,�
E ecuted in V County, State of � 1� on the day of 20�.
X (month) (year)
Signature of db6orized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.3a6aaf7d
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
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. 2019-557048
ProDirt Services, LLC
Hutto,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 10/30/2019
being filed.
City of Round Rock Date Acknowledged:
11/07/2019
g 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
Roadwork
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Dill,Tony Hutto,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 Texas Ethics Commission www.ethics.state.tx.us Version V1.1.3a6aaf7d