Contract - Partners Remodeling, Restoration, & Waterproofing - 10/8/2020P age l of 3
r�'.'/"rNO
(y�yC
rev, 01/ 16
Department:
Project
Name:
City Project
ID Number
Contract Quantity Adjustment/Change Order
23000
Clay Madsen Recreation Center Restroom Project Date:
Change Order/Quantity
Adjustment No.
9/ 10/20
1
Partners Remodeling, Restoration &
Vendor Waterproofing 3219 Harpers Ferry Lane Austin, TX 78745 512-825-3950
Company Name Address Phone No.
Justification
:lectrical service provided during the construction of the new soccer fields was designed to accommodate the future power needs of a prefab
estroom. However, PARD ended up purchasing a different prefab restroom than the one designed for, which will require a transformer to
upport. Irrigation for this area was originally included in the scope of another project, but had to be removed because the restroom had not yet
seen installed. Minor changes in the field necessitated the addition of cast iron boots over clean outs and additional sidewalk to meet ADA
equirements. Contractor issued credit for not havinq to trench as much as anticipated for electrical conduit.
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
$42,516.75
$0.00
$0.00
$0.00
$42,516.75
$0.00
0%
$9,475.00
22%
$9,475.00
22%
$51,991.75
$9,475.00
45 days
none
none
45 days
Submitted for Approval ''
Prepared By: Rachel Morris, Park Development Specialist, CORR d
Signature Printed Name, Title, Company Date
ry A o aIs
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Contractor: . , rZ / e:114P)Oj2�t C:
SignatuKc Printed Name, Title, Company Date
City Project
Manager: Z.aJ"A "O v-V oS ?a -ark , S GO (to I ZD
Si natu Printed Name, Title Date
Mayor/City
Manager,
d /
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Signatur PrintecVName, Tie Date
go-e zVU�Q2i5
Page 2 of 3
Contract Quantity Adjustment/Change Order
RMNO UMCK TEXAS
rev, 01/ 16
Project Name: Clay Madsen Recreation Center Restroom Project
Quan. Adj./Change Order No.:
Change Order Data
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
(Days)
1
Purchase & install new transformer
LS
1
$4,200.00
$4,200.00
0
2
Install irrigation around new restroom
LS
1
$4,200.00
$4,200.00
0
3
Install 4 additional cast iron boot over
clea nouts
LS
1
$1,000.00
$1,000.00
0
4
Install additional sidewalk to meet ADA
LS
1
$825.00
$825.00
0
5
Credit for not trenching entire electrical
conduit
LS
1
-$750.00
-$750.00
0
TOTALS:
9,475.00
0
Page 3 of 3
Contract Quantity Adjustment/Change Order
R[a NO ROM 7`EX�A$
rev, 01/ 16
Project Name: Clay Madsen Recreation Center Restroom Project
Quan. Adj./Change Order No.:
Quantity Adjustment Data
Contract
Time
Adjustment
Item Description Unit Qty. Unit Price Amount (Days)
TOTALS: $0.001 0
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My adctre�. is'�►'??l�+� ...�,,....��.�i� �r7y ��•
declare urwd penaity of perjury that the tore�oirtg is tnie and *.,orrect:
�atscttt�i ih ��County. S he cf on ths..�day of � . 2U.�,�„�;.
' rc Qf utltiarized a�eMof c<c��tracting business er►Uiyr
orrns Pravid+eti i�t Te�s.Eth�cs �omtnissti�un wravw.ethicsst�te,tx:us Ve►sion V1.1.6aaf7d
4 Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Besa, Patsquinel
Besa, Juan
Austin, TX United States
Austin, TX United States
X
X
Besa, Daniel
Austin, TX United States
X
5 Check only if there is NO Interested Party. 1:1
6 UNSWORN DECLARATION
My name is
My address is
(city)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in
County, State of
and my date of birth is
(state)
(zip code)
on the day of
(month)
(country)
,zo �w
(year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission wwwethics.state,tx,us Version V1.1.3a6aaf7d