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Contract - JD Abram - 11/18/2021 Page I of 3 RWNO RO«fF%AS Contract Quantity Adjustment/Change Order rev,01/16 Department: TrQ��LiO� rvf I Vh Project Name: UNIVERSITY BLVD EXPANSION Date: I� City Project Change Order/Quantity ID Number Adjustment No. 1 Vendor 3. D.ABRAMS L.P. 5811 Trade Center, Bldg 1,Austin TX 78744 512-322-4000 Company Name Address Phone No. Justification Traffic Signal revisions and added bid items.Correcting pavement marking bid items.Adding item for off-duty law enforcement for traffic safety during lane closures.Additional need for erosion control fence identified on site. SUMMARY Amount % Change Original Contract Price: 1 $11,104,890.47 Previous Quantity Adjustment(s): $0.00 . 1 i fi�e k t` This Quantity Adjustment: $14,469.34 , +, Total Quantity Adjustment(s): -$14,469.34 Total Contract Price with Quantity Adjustment(s): $11,090,421.13 Previous Change Order(s): $0.00 0% This Change Order: $177,851.13 2% Total Change Order(s)To Date: $177,851.13 2% Adjusted Contract Price [Original Contract Price Plus Quantity Adjustment(s)Plus Change Order(s)]: $11,268,272 26 "(i Difference between Original and Adjusted Contract Prices: $163,381.79 Original Contract Time: Time Adjustment by previous Quan.Adj./Change Order: Time Adjustment by this Quan.Adj./Change Order: New Contract Time: 0 'SwbnftW for Approval Prepared By: Jacob Woehr, Project Manager, J. D. Abrams, LP 10/14/2021 Signature Printed Name,Title,Company Date Q� Approvals Contractor: Steven Zbranek, VP of Operations, J.D. Abrams, L.P. 10/14/2021 Signature Printed Name,Title,Company Date City Projec" �� �C� ' (� ��� c ! .L �l" 1�( O Manager• �� Q JCYItLI`2,G W( c an Q�E.(- ( 11S 1 7za igXure Printed Name,Title J Date Mayor/City cY Manager 3 ?=I- -sioAat6re Printed Name,Title Date R-2021� 30q Page 2 of 3 NORr'X4 Contract Quantity Adjustment/Change Order ev,01/16 Project Name: UNIVERSITY BLVD EXPANSION Quan.Adj./Change Order No.: 1 Change Order Data Contract Time Adjustment Item # Item Description Unit Qty. Unit Price Amount (Days) 0624-6008 GROUND BOX TYPE C W/APRON EA 28.00 $1,540.00 $43,120.00 0680-6004 REMOVING TRAFFIC SIGNALS EA 2.00 $4,162.50 $8,325.00 INS TRF SIG PL AM (S) 1 ARM(55') LUM 0686-6060 &ILSN EA 2.00 $27,390.00 $54,780.00 REFL PAV MRK TY I(Y)4" 0666-6126 (SLD)(100MIL) LF 37,832.00 $0.39 $14,754.48 REFL PAV MRK TY I(W)4" 0666-6012 (SLD)(100MIL) LF 36,830.00 $0.44 $16,205.20 0620-6009 ELEC CONDR-NO. 6 BARE LF 363.00 $1.65 $598.95 0624-6002 GROUND BOX TYP A(122311)W/APRON EA 4.00 $990.00 $3,960.00 0628-6002 REMOVE ELEC SERVICES EA 1.00 $357.50 $357.50 ELC SRV TY D 120/240 070-NS-AL-E-TP- 0628-6167 0 EA 1.00 $4,950.00 $4,950.00 9606-6053 LAW ENFORCEMENT PERSONNEL DOL 30,800.00 $1.00 $30,800.00 $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: 1 , .1 Page 3 of 3 Contract Quantity Adjustment/Change Order ROUND ROQt tkXTS rev,01/16 Project Name: UNIVERSITY BLVD EXPANSION Quan. Adj./Change Order No.: 1 Quantity Adjustment Data Contract Time Adjustment Bid Item # Item Description Unit Qty. Unit Price Amount fnavci 0666-6140 REFL PAV MRK TY I(Y)12"(SLD)(090MIL) LF (37,478.00) $0.39 -$14,616.42 REFL PAV MRK TY I 0666-6008 (W)4"(LNDP)(090MIL) LF (36,830.00) $0.44 -$16,205.20 0618-6046 CONDT(PVC) (SCH 80)(2 IN) LF 247.00 $10.50 $2,593.50 0618-6047 CONDT(PVC) (SCH 80)(2 IN)(BORE) LF 186.00 $26.25 $4,882.50 0620-6007 ELEC CONDR(NO. 8) BARE LF 105.00 $1.58 $165.90 0620-6008 ELEC CONDR(NO. 8)INSULATED LF (192.00) $1.26 -$241.92 0620-6010 ELEC CONDR(NO. 6)INSULATED LF 622.00 $3.15 $1,959.30 0506-6038 TEMP SEDMT CONT FENCE(INSTALL) LF 1,332.00 $5.25 $6,993.00 $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 TOTAL : 14 469.34 0 CERTIFICATE OF INTERESTED PARTIES FORM 1295 t �rl t G.nnplew Nos.1-4 taxl 6 it there are interested parties. OFFICE USE ONLY Complew Nos.1,2,3,b,and 6 it there are no intereste(I parue`` 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. 2021-18!)094 J.D.Abrams L. P. Austin,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 (Idf(!21?OJI being filed. City of Round Rods Transportation Department Date Acknowledged: 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 tinder the contract. Kenney Fort Blvd-Seg 2&3 Furnishing all labor,materials and equipment and perfortrling all work required for the ConsbA d on of K(quiey I ott Blvd Segrnentc; 2 and 3 el Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I internteriiav Gallaghei,Kelly Austin,TX United States X Fernandez,Alfonso Austin, TX United States X Everett,Brad Austin, TX united States X Abrams,Jon Austin,TX United States X 5 Check only if there is NO Interested Party. Q 6 UNSWORN DECLARATION My name is 14,t _. and my date of birth is My address is J� .{sltraJit) f , � UI (-dty) (state) (zipccxfe) (ctww I declare under pena-llt'yy(A perjury that the foregoing is true and correct.Executed it) ! F I Try i� County, State of X AS__ on the 3 Y ay of 20 2— . (m- (year) l {)nature of autl r: ell agent of contract business entity {Oetclar.mt} I orris provided by Texas Ethics Commission vMv.e(hics.StaIe.tx.US Version V1.Lc.cffd98;1 CERTIFICATE OF INTERESTED PARTIES FORM 1295 10fl Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 it 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. 2021-817619 J.D.Abrams,LP Austin,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 10/27/2021 being filed. City of Round Rock Transportation Department Date Acknowledged: 10128/2021 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. 000000 University Blvd C0#1 University Blvd QA1CO#1 — Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Gallagher,Kelly Austin,TX United States X Everett,Brad Austin,TX United States X Fernandez,Alfonso Austin,TX United States X Abrams,Jon Austin,TX United States X 5 Check only if there Is NO Interested Party. El 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (state) (lip 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 (DLdarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc