Contract - Prota Construction, Inc. - 9/10/2020Page I of 3
Contract Quantity Adjustment/Change Order
rev, 01/16
Department: Utilities & Environmental Services
Project
Name: PRV #21 #41 #9 & BCRUA and Line Extension Date: 6/30/20
City Project Change Order/Quantity
ID Number SEPMP Adjustment No.
Vendor PROTA Construction Inc & PROTA Inc., J.V. P.O. Box 342195 Austin, TX 78734
1
Company Name Address Phone No.
Justification
Several Change Order Proposals
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:
Amount % Change
$869,620.50
$0.00
-$5,656.90
-$5,656.90
$863,963.60
$0.00 0%
$67,005.00 7.76%
$67,005.00 7.76%
$930,968.60
$61,348.10
270 Days
0 Days
54 Days
324 Days
Submitted for Approval
Prepared By:
.�in.
8 , (S ,
(igna re
Printed Name, Title, Company
Date
Approvals
Contractor:
Kermoth M. Flores Garcia, ProoectAugust
17 2020
Signature
Printed Name, Title, Company
Date
City Project
Manager:
7:6
na
Printed Name, Title
Date
Mayor/City
Manager
.
4
910,
Sig nat e
Printed Wame, Title V
Date
iZ-?A2o---- Z)**'L"5t
This Page is too large to OCR
Page 2of3
Contract Quantity Adjustment/Change Order
rev, 01/16
Project Name: PRV #2, #41 #9 & BCRUA and Line Extension
Quan. Adj./Change Order No.:
Change Order Data
Contract
Time
Adjustment
Item #
Item Description
Unit
Qty.
Unit Price
Amount
(Working Days)
A/C Pipeline at PRV #2 6" Gate Valve
COP # 1
Installation
LS
1
$2,770.00
$2,770.00
0
COP #2
DI Pipeline Installation at PRV #2
LS
1
$1,256.00
$1,256.00
0
Change due to shift PRV #2 from OCV to
COP #3
Cla-Val, Including BFV w/ Actuator
LS
1
$7,859.00
$0.00
0
16" MJ Gate Valve Installation at BCRUA
COP #4
Site
LS
1
$18,571.00
$18,571.00
30
Furnishing 30" MJ Gate Valve at BCRUA
COP # 5
Site
LS
1
$141626.00
$14,626.00
0
Furnishing 30" Factory Restrained DI
COP #6
Pipe
LS
1
$0.00
$0.00
0
COP #7
4" DI Pipeline Relocation
LS
1
$2,430.00
$2,430.00
0
Repair Existing Spool Set-in in the
COP #8
Concrete Wall
LS
1
$2,701.00
$2,701.00
0
New Layout for PRVs to be installed at
COP #9
BCRUA Site
1
$3,760.00
$3,760.00
0
Build Deadman (Additive) & Connection
COP # 10
of Pipelines at PRV #9 (Deductive)
LS
1
$3 642.00
$3,642.00
4
Installation of 16" x 12" MJ Reducer at
COP # 11
PRV #9
LS
1
$917.00
$917.00
0
COP # 12
North 81 Standpipe Works
LS
1
$0.00
$0.00
0
Build Deadmen at the New 18" Gate
Valve installed at PRV ##9 and the
Existing 16" Butterfly Valve at the North
COP # 13
of the proposed PRV Concrete Vault
LS
1
$8,026.00
$8,026.00
5
COP #14
18" MJ Gate Valve Installation Credit
LS
1
-$121310.00
-$121310.00
0
Additional Fittings for Installation of 18"
MJ Gate Valve due to the existing
COP #15
pipeline is 20".
LS
1
$7,899.00
$7,899.00
5
Connection of Pipeline at the North and
COP #16
the South sides of PRV #9
LS
1
$11,059.00
$11,059.00
5
Additional Conduits and Wiring at BCRUA
COP #17
Site
LS
1
$1,658.00
$1,658.00
0
$0.00
$0.00
$0.00
TOTALS:
$67,005.001
49
Page 3of3
Contract Quantity Adjustment/Change Order
RMINO ME";
rev, 01/16
Project Name: PRV #2, #4, #9 & BCRUA and Line Extension
Quan. Adj./Change Order No.:
Quantity Adjustment Data
Bid Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
34
Extra Hand Excavation
CY
50
-$110.00
-$5 500.00
0
35
Extra Machine Excavation
CY
50
-$65,00
-$3 250.00
0
36
Extra Placement of Backfill Material
CY
50
-$65.00
-$31250.00
0
30
Remove and Dispose Sidewalk
SY
56.55
$42.00
$2,375.10
2
31
4" Sidewalk
SY
64
$62.00
$3,968.00
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:
- 5 656.90
5
CERTIFICATE t3F tI�TERE�TED PARTIES �c�Rnn 1295
1.0ti
CO- --------- -------------
- --------- -- ----------- -- - ------- ----
Ml------ . ... ..
mp►eCe Nos. i - 4 and. B if there are interested pa�ies. OFFICE U'S.E�-0*N'LY
Complete Nos. i; 2, 3, 5.., and 6 if there are no interested paRies, CERTlFl*CATl0N 0FFILI. .. ...... .
N+G.
Name of bUsirtesa ent�#y filing farm. and the city, state sm..d coauntry of the business entity's platco-Cer#iilcate Number:
ot business. 2t}20-661297
Frota �on.s..ructtian Inc and Prota inc, JV
Austin, TX United States Date sited- ---------------- --------- --- -- - -- --------------- - ------- :
2 Name o4'gvvsrnmer�ta ent ty ",
ot-state agency that: I"'s a part�r t� t e ---------------------
contract cr which the form is /2,6/2-020
being tCied.
City of.Round Rock Dtte--.--Ac'kn'o-w'ledged:
� Provide. tbtldentiftcasian n.,um.ber us-'s-d by the governmental amity .or Mate agency lo,track..or Identrify the contact, and'.proAde.a
descriptlon:of the se-rvices, goads, or other property to be provided under the c�sntrect
Ptessure Reducing Valve
Quantity A�jusEmentlGhar�ge 0..der Na, i far the.Pressure Ft�da�ing Valves 2-4 4�, 9 and BC.RUA Valve &Line Extension project
Nature . ...
.. ........ --------- -- -- - -- -----
------- -- ----
— -----------
ot'Intetest
4 Name of Inteteste.d..,Party City, State, Country (place of business) (check appileablej
011110
ControUi lntermedia
Borg, Michelle Au-------- ----
------------- ---------------- ------ VMW_ W W
stin,. TX United States X X
--------------------- --------- .... ..... . .. ... . . ... .... ----------------
-imam --- Man - - - — ---------------- - .. ... .. ------------------ --- -
MIAMI _W__ . . .. .....
NO .. .... ....
Prota, Inc. Austin, TX United States X
Sp -10
Prota-Constructlon, inc. Mlyague-Z Mayaguez Puerto Rieo X
-------------
Ta.mlboe-r, Cornelius A-pstJn.-,TX'U'.nl.ted States X X
. ..... . ...... .. -------- _00 _01 _1111111-0110i
i mn ------ --- ------ Ill Mill
-WIN ------ -11 i-Wi
Aco�tar Ric'.ardo Mayagusa Puerto Rico, USA X X
. . ... . .....
10
---------------
---------------
5 Cheek only if there:Is.NO lntorested Party.
- --- ------ - ----- - -------------
----- ------------ _01-1 ----------------- - ------ -- .. .. . ......
8 U-N,S-W0-RN-DEC.L.A.-Ran-TION
My name is MicheNe Botg ,and.my date of birth is �egtember 2�. 1,976.
..
My addres-s-:1. ll-aloraft.Dr.ive ,Austin � TX 78730 � USAM11I
(street). (aKyy Ate) (z!p code) (�untry)
1 declare under penalty of perjury that the foregoing- is true •and.-*,.Qrrect,
Executed ln Trsvls.County, Stara at ��xs� . on the. 2Lday of August , 2.0 2
. . ..... ......
h l (Year).
Signature a au r zed agenE of contrac�tng busMness entity
(Dederant}
Forms provided by Tex.as. Ethics Commiss
ion vww.ethics.state.bc.us Version Vlol.,3
a6
aat7a
CERTIFICATE OF INTERESTED PARTIES FORM 1295
10fl
Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos, 1, 21 31 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. 2020-661297
Prota Construction Inc and Prota Inc, JV
Austin, TX United States Date Filed:
2 Name of governmental entity or state agency that i s a party to the contract for which the form is 08/26/2020
being filed.
City of Round Rock Date Acknowledged:
08/26/2020
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-Pressure Reducing Valve
Quantity Adjustment/Change Order No. 1 for the Pressure Reducing Valves 2, 41 9 and BCRUA Valve & Line Extension project
4 Name of Interested PartyCity,State,
Country of business)
Nature of interest
a licable PP
Controlling
Intermediary
Borg, Michelle
Austin, TX United States
X
X
Prota, Inc.
Austin, TX United States
X
Prota Construction, Inc.
Mayaguez Mayaguez Puerto Rico
X
Tamboer, Cornelius
Austin, TX United States
X
X
Acosta, Ricardo
Mayaguez Puerto Rico, USA
X
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)
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 . eth i cs . state . tx . u s Version Vl,1,3a6aat7d