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Contract - Thalle Construction - 5/27/2021Page 1 of 2 Contract Quantity Adjustment/Change order F a�arUNO ROCK rExAS rev, 01/ 16 Department: Project Name: Brushy Creek Regional Wastewater System — East Plant Date: 5/4/21 City Project Change Order/Quantity ID Number R-2020-0090 Adjustment No. CO-01 Vendor Thalle Construction Company 900 NC 86 North, Hillsborough, NC 27278 Company Name Address Phone No. 3ustification Optional Deduct Items removed from the project after design. Unforseen conditions related to Industrial type doors, stainless steel plate at primary treatment unit, unknown conflict for communication fiber at East electrical building and Main power transformer pads requirements added by Oncor. Unknown buried utilities resulting in additional work for removal and shoring for impacted construction sequencing. Switching from low bidder for instrumentation equipment to match existing equipment. Refurbishment of existing BFP equipment to include additional work. SUMMARY Amount % Change Original Bid Price: $1071351,712.60 Previous Quantity Adjustment(s): This Quantity Adjustment: Total Quantity Adjustment(s): Total Contract Price with Quantity Adjustment(s): $1071351,712.6 Previous Change Order(s): $0.00 0% This Change Order: $615,302.02 0.6% Total Change Order(s) To Date: $615,302.02 0.6% Adjusted Contract Price [Original Contract Price Plus Quantity Adjustment(s) Plus Change Order(s)]: $107,967,014.62 Difference between Original and Adjusted Contract Prices: $615,302.02 Original Contract Time: 975 Time Adjustment by previous Quan. Adj./Change Order: 57 Time Adjustment by this Quan. Adj./Change Order: New Contract Time: 1032 Submitted for ApPva Prepared By: �j.. Sign& re Printed Nam , Title, ompany Date Approval Contractor: c06 4�1 0.5 • Z. Zs1 Signatur Printed Name, Title, Company Date City Project f ' Manager: Lj� � -�) � Signat Printed Name, Title Date Mayor/City I MManager 1M'2ma SignaturPrinteame, Tit Date ��1��� Page 2 of 2 Project Name: Brushy Creek Regional Wastewater System —East Plant Quan. Adj./Change Order No.: CO-01 Chance Order Data Item # Item Description Unit Qty. Unit Price Amount Contract Time Adjustment PCM-005 Alternative Analytical Instruments Manufacturer 1 1 $520734.36 $52,734.36 0 PCM-007 Modifications to Alum. chemical feed 1 1 $5,254.06 $5,254.06 0 PCM-009 PTU Dumpster Track Plate Material 1 1 $17,867.94 $17,867.94 0 PCM -013 Hurricane rated doors vs Torrnado rated 1 1 $35,126.00 $35,126.00 0 PCM-014 Plant NPW Pumps to Remain 1 1 $2,496.63 $2,496.63 PCM-015 Fiber Optic Re -Route at East Electrical Building 1 1 $13,455.86 $13,455.86 0 PCM-016 Oncor Transformer Pad Piers Addition 1 1 $10,538.35 $10,538.35 1 PCM-023 Additional Walls at AB 1 & 2 1 1 $7,687.22 $7,687.22 1 PCM-025 Flow Meter Manufacturer Change 1 1 $1,685.67 $1,685.67 0 PCM-026 AB3 - Removal of Duct Banks 1 1 $15,000.00 $15,000.00 30 PCM-027 NPW Yard Piping at Se to a Station 1 1 5 331.65 $5,331.65 1 CMR-2 Electrical & Comms Relocation 1 1 $13,455.86 $13,455.86 0 CMR-4 PTU Pier Casing 1 1 $55,610.17 $55,610.17 10 CMR-6 Additional Conduits per RFI 18 1 1 $9,867.93 $9,867.93 7 CMR-7 Electrical assitance to Plant staff 1 1 $1,241.30 $1,241.30 0 CMR-8 Existing Duct Exploration 1 1 $2,668.98 $2,668.98 0 CMR-9 Belt Filter Refurbishment 1 1 $365,280.04 $365,280.04 0 'ABaed CMR-10 Construction Days Due to Weather February 2021 1 1 $0.00 $0.00 7 TOTALS: $615.302 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 i Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number: of business. 2021-743976 Thalle Construction Alvarado, 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 04/27/2021 being filed. City of Round Rock Date Acknowledged: 04/27/2021 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 Change Order No. 1 regarding the Wastewater Treatment Plant Expansion Project Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary Thalle Construction Company Inc. Alvarado, 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 �1 (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 wwweth-ics.state,tx,us version vl.t.cenayua voA,im-ivao., �. sn*xoaams•so►ura,*rauinm uolss�wuaoc) SDIzi33 01.� P��St.jao AL own. 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