Contract - G. Hyatt Construction, Inc. - 3/26/2020 Pacre 1 of 3
Contract Quantity Adjustment/Change Order
rev,08!12
Department: Transportation Department
Project City of Round Rock-Streetscapes
Name: Improvements Date: 3/2/20
City Project Change Order/Quantity
ID Number Adjustment No. 3
Justification
1. Change Proposal # 9-Revised. Provide&Install approx. 120 LF of 18"Storm drainage&associated work at Parklets C&D. $63,027.80
SUMMARY Amount %Change
Original Contract Price: $2,390,391.58
Previous Quantity Adjustment(s): $67,861.60
This Quantity Adjustment: $63,027.80
Total Quantity Adjustment(s): $130,889.40
Total Contract Price with Quantity Adjustment(s): 2,521,280.98
Previous Change Order(s): 0.00
This Change Order: 0.00
Total Change Order(s)To Date:
$0.00 0.00
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $2,5211280.98
Difference between Original and Adjusted Contract Prices: $130,889.40
Original Contract Time: 275
Time Adjustment by previous Quan.Adj./Change Order: 14
Time Adjustment by this Quan.Adj./Change Order: 7
New Contract Time: 296
Submitted for Approval
Prepared By:
Signature Printed Name,Title, Company Date
Approvals
Contractor: Justin Hyatt, President,G. Hyatt Construction,Inc. 3/2/20
4kco'"-J�
natur Printed Name,Title, Company Date
City ProjectManager: �'.l l.J� ��� �C �C�� 'f;. Z ZOZ D
Signa re Printed Name,Title Dat
Mayor/Cit,/ManagerOmiAC
Signat re V Printed ame,TitV Date
Page 2 of 3
Contract Quantity Adjustment/Change Order
�Rounnaocic ins
rww.,.uvx:,w�sur
rev,08/12
Project Name: City of Round Rock-Streetscapes Improvements
Quan.Adj./Change Order No.: 3
Change Order Data
MWMMS
Contract
Time
Adjustment
Item# Item Description Unit Qty. Unit Price Amount
Additional storm drainage for parklets
C&D- Per change proposal #9-Revised
1.05 dated 2/27/2020 LS 1 $63,027.80 $63,027.80 7
$0.00
$0.00
$0.00
$0.00
$0.00
0.00L-
0.001
$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:TOTALS:J $63027.80 7
i
I
i
i
,: Quantity-. Unit Unit Price Extended
Mobilization,O&P for Utility Contractor 1 LS $ 7,500.00 $ 7,500.00
18"RCP 120 LF $ 241.28 $28,953.80
Curb Inlets&Grates 2 EA $ 3,950.00 $ 7,900.00
Connect/Tie Into Existing Inlets 2 EA $ 2,555.00
$ 5,110.00
Flowable Fill Backfill-Parklet C 32.5 CY $ 195.00 $ 6,337.50
3 Mil Water Barrier 500 SF $ 3.00 $ 1,500.00
Haul Off Spoils 82 CY
$ 25.00 $ 2,050.00
Trench Safety 1 LS $ 1,239.00 $ 1,239.00
Backfill w/Spoils-Parklet D 32.5 CY
$ 75.00 $ 2,437.50
$63,027.80
CERTIFICATE OF INTERESTED PARTIES FORM 1.295
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
1 Name of business entity filing farm,and the city,state and country of the business entity's place Certificate Number:
of business. 2020-596059
G Hyatt Construction, Inc.
Leander,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 03/05/2020
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 services,goods,or other property to be provided under the contract,
Downtown Streetscapes
General Construction
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Hyatt,Justin Leander,TX United States X
i
i
i
i
i
5 Check only if there is NO interested Party.
6 UNSWORN DECLARATION
i
E My name is n ( and my date of birth is
i
My address is
i
(street) (city) (state) (zip code) (country)
i —- 1-declare under-penalty of perjc7 that the foregoing is true and correct,-
Executed
orrect.- -Executed in r 1 G �l�/�lf
County, State of � ti"S ,on the day of AeaA
(month) _.(year)
i Signatur qP uthoriz , e o ontracting business entity
/ (p6�clarar)
Forms provided by Texas Ethics Commission www.ethics.s te.txru � Version V1.1.3a6aaf7d
i � �
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2020-596059
G Hyatt Construction, Inc.
Leander,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 03/05/2020
being filed.
City of Round Rock Date Acknowledged:
03/09/2020
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.
Downtown Streetscapes
General Construction
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Hyatt,Justin Leander,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