Contract - Chasco Constructors - 6/25/2020 (2)Pagel of 3
Contract Quantity Adjustment/Change order
rev, 01/16
Department: Transportation
Project
Name: Harrell Pkwy & Brushy Creek Plant Road Date: 5121/20
City Project Change Order/Quantity
ID Number Adjustment No. 5
Vendor Chasco Constructors PO Box 1057, Round Rock, TX 78680 512-244-0600
Company Name Address Phone No.
Justification
Railpros invoices for fiagger at Harrell Pkwy & BCWTP Intersections
!) Provide range extenders & reroute power & com to blower bldg. for gate controller
I) Concrete access drive to UPRR signal house
bU M MAK Y
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
Amount % Change
E $3,549,994.40
$0.00
$0.00
�_ -- $3,549,994.401
$301,884.00
$76,859.00
$378,743.00
$3,928,737.40
242
81
31
354
$378,743.00
Contractor:
Signature Printed Name, Title, Company Date
City Project
Manager: / �Elw —Z(o —2D
Sign
atur Printed Name, Title Date
Mayor/City
Manager 01N � , � .2M
Signatur Printed Rdme, TitleU Date
Project Name: Harrell Pkwy & Brushy Creek Plant Road
V,-UU-0J('f'
Page 2 of 3
rev, 01/16
Contract Quantity Adjustment/Change Order
Quan. Adj./Change Order No.
Chance Order Data
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
1
Railpros Inv. #CC1501620200309
LS
1
$14,872.00
$14,872.00
6
Railpros Inv. CC 5 04
L
1 , 4 .
,
3
Railpros Inv. #CC1501620200430
LS
1
$28,524.00
$28,524.00
11
4
Wildcat Power & Comm CO #1
LS
1
$7,115.00
$7,115.00
3
5
Concrete driveway for UPRR signal house
LS
1
$7,500.00
$7,500.00
3
$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
TOTALS:J
$76,859.00
31
Project Name: Harrell Pkwy & Brushy Creek Plant Road
Page 3 of 3
�` j.- Contract Quantity Adjustment/Change Order
"/ No Rx::-:
rev, 01/16
Quan. Adj./Change Order No
Quantity Adiustment Data
Bid Item #
Item Description
1 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
TOTALS:
$0.001
0
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
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.
2020-622615
Chasco Constructors
Round Rock, TX United States
Date Filed:
05/21/2020
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:
06/19/2020
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.
18132
1. Railpros invoices for flagger at Harrell Pkwy & BCWTP intersections. 2. Provide range extenders & reroute power & com to
blower bldg for gate controller 3.Concrete access drive to UPRR signal house
Nature of interest
4 Name of Interested PartY
City, State Count lace of business
Y Country �P )
check applicable)
� PP )
Controlling
intermediary
Bambrick, Bill
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)
Gnrmc nrnviriari by TaYac Fthics t .nmmissinn www.ethirs-state.tx.us Version V1.1.3a6aaf7d
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.
2020-622615
Chasco Constructors
Round Rock, TX United States
Date Filed:
05/21/2020
2 Name of governmental entity or state agency that is a party tot the contract for which the form is
being filed.
City of Round Rock, Texas
Date Acknowledged:
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 tile contract,
18132
1. Railpros invoices for flagger at Harrell Pkwy & BCWTP intersections. 2. Provide range extenders & reroute power & corn to
blower bldg.for gate controller 3.Concrete access drive to UPRR signal house
Nature of interest
4 Name of Interested Part Y
City, State County lace of business
Y� � Y iP )
check applicable)
t pp )
Controlling
Intermediary
Chuck Glace
Round Rock, TX United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is Chuck Glace and my date of birth is
My address is 2801 East Old Settlers Blvd Rock , Tx 7866.5 USA
_Round
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct,
Executed In Williamson County, State of Texas on the 21stday of May 20 20
(month) (year)
Signature of autho ized agent of co tr ing business entity
(Declarant)
Pnrmc nrnviripri by Texas Fthics Commission www.ethics.state.tx.us Version V1.1.3a6aat7d