Contract - PM Construction - 3/11/2021Page I of 3
rev, 01/16
Department:
Project
Name:
City Project
ID Number
Vendor
Justification
Contract Quantity Adjustment/Change Order
UES
Lake Creek 10 & 11 Wastewater Improvements Date: 2/10/21
Change Order/Quantity
LCPID Adjustment No. 1
PM Construction & Rehab, LLC 131 North Richey Road - Pasadena, TX 77506 (832) 252-4811
Company Name Address Phone No.
Quantity Adjustment No. 1 is needed for final quantity adjustment.
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:
Submitted for ApEprr*vall
55
55
Amount
$5911935.00
$0.00
-$55,692.15
-$55,692.15
�v
$5361242.85
$0.00
$0.00
$0.00
$536,242.85
$55,692.15
Change
0%
0%
0%
Prepared By: Eddie Zapata, Senior Project Manager, City of Round Rock 2/22/21
Signature Printed Name, Title, Company Date
Approvals
Contractor:, Emily High, Project Manager, PM Construction & Rehab, LLC
1
City Project"
Manager.
Sig natu
Mayor/City
Manager
Sigrt6tu
Printed Name, Title, Company
Eddie Zapata, Senior Project Manager
Printed Name, Title
Craig Morgan, Mayor
Printed Name, Title
Date
Date
Date
Page 2 of 3
Contract Quantity Adjustment/ Change Order
RQU149 ROCK I'EX As
rev, 01/16
Project Name: Lake Creek 10 & 11 Wastewater Improvements
Quan. Ad]./Change Order No.:
I'hanna nrri®r r%n+n
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
(Days)
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS:
$o.®®
0
Page 3 of 3
Contract Quantity Adjustment/Change Order
"Po-FEXAS
rev, 01/16
Project Name: Lake Creek 10 & 11 Wastewater Improvements
Quan. Adj./Change Order No.: 1
Ouantitv Adjustment Data
Bid Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
1
Asphaltic Concrete Pavement Repair
SY
-10.45
$90.00
-$940.50
55
2
Concrete Drainage Repair
SY
-21.67
$85.00
-$1,841.95
3
P. C. Concrete Curb and Gutter
LF
-95
$40.00
-$3,800.00
4
New 4" Concrete sidewalk
SF
-265
$42.50
-$11 262.50
5
Concrete Driveway Repair
SY
-93.23
$90.00
-$8,390.70
9
Removal of Existing Manhole 4' dia.
EA
1
$2,850.00
$2,850.00
10
New Manhole Construction
EA
-3
$5,250.00
-$151750.00
12
Trench Safety Systems
LF
-2050
$1.00
-$2,050.00
13
12" Dia. SDR-26 PVC in 24" Steel Encasement
LF
46
$97.50
$4,485.00
14
12 Dia. SDR-26 PVC (all depths)
LF
-9
$85.00
-$765.00
15
15 Dia. SDR-26 PVC (all depths)
LF
-9
$105.00
-$945.00
16
Pre- CCTV
LF
164
$4.50
$738.00
17
Post - CCTV
LF
14
$1.25
$17.50
18
Installing or Reconnecting Service
EA
1
$645.00
$645.00
19
Open Cut - Rehab/Install 12 " Sewer Line
LF
-11
$175.00
-$1,925.00
21
Stabized Construction Entrance
EA
-6.5
$1,550.00
-$10,075.00
22
Silt Fence
LF
-1554
$1.50
-$2,331.00
24
Wood Fence
LF
-60
$15.00
-$900.00
26
Pipe burst 8" to 10" DR19
LF
-33
$42.00
-$1,386.00
27
Pipe burst 8" to 12" DR19
LF
-16
$50.00
-$800.00
28
Pipe burst 10" to 12" DR 19
LF
-23
$55.00
-$1,265.00
$0.00
$0.00
$0.00
$0.00
TOTALS:
- 55 692.15
55
CERTIFICATE O,F::'INT TED PARTIES FORM 1295.
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
10fl
Complete Nos, 1 w 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos. i, 21 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. 202lm723709
PM Construction & Rehab, LLC
Pasadena, 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 03/05/2021
being filed.
City of Round Rock Date Acknowledged:
03/10/2021
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
Lake Creek 10 & 11
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
IPR AcquisitionCo, Inc.
Conyers, GA 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 I - I
(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�6
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www,ethics.stateAx,us Version Vl.l.ceffd98a