Contract - Cash Construction - 12/2/2021 Paget of 3
'}^4 Contract Quantity Adjustment/Change Order
m,01/16
Department: UES
Project
Name: Northeast DowntownRevitalization Date: 11/17/21
City Project Change Order/Quantity
ID Number NEDTU/NEDTR Adjustment No. 4
Vendor Cash Construction 217 Kingston Lacy Blvd.-Pflugerville,Texas 78660 (512)251-7872
Company Name Address Phone No.
Justification
Change Order/Quantity Adjustment No.4 is for installation of concrete headwall at end of Sheppard Street near Ruby Hotel and for bid item quantity overages.
SUMMARY Amount %Change
Original Contract Price: ::$:162,3:06.225
Previous Quantity Adjustment(s):
This Quantity Adjustment:Total Quantity Adjustment(s):Total Contract Price with Quantity Adjustment(s):
Previous Change Order(s): $391,749.20 5%
This Change Order: $169,100.00 2%
Total Change Order(s)To Date: $560,849.20 7%
Adjusted Contract Price [Original Contract Price Plus Quantity Adjustment(s)Plus Change .,,.
Order(s)]: $8,546,935.45
Difference between Original and Adjusted Contract Prices: $723,155.45
Original Contract Time: 365
Time Adjustment by previous Quan.Adj./Change Order: 0
Time Adjustment by this Quan.Adj./Change Order: 90
New Contract Time: 455
Prepared By: Eddie Zapata,Senior Project Manager,City of Round Rock 11/18/21
Signature Printed Name,Title,Company Date 1
Contractor: Michael Stevens Project Manager,Cash Construction
Si re Printed Name,Title,Company D71,e
City Project
Manager: C � LL Eddie Zapata,Senior Project Manager /Z—�
Signa ur Printed Name,Tide to
Mayor/City fj
Manager Craig Morgan,Mayor L (�
Signatu7f Printed Name,Title D to
IZ 262(-32B
1'a_i-'111
Contract Quantity Adjustment/Change Order
ROIINO ROCK iI -
ev,01/16
Project Name: Northeast Downtown RevitaIization
Quan.Adj./Change Order No.: 4
Change Order Data
Contract
Time
Adjustment
Item# Item Description Unit Qty. Unit Price Amount (Days)
CO 4-1 Construction Layout LS. 1 $6,750.00 $6,750.00 90
CO 4-2 Rock Excavation and haul off LS. 1 $17,000.00 $17,000.00
CO 4-3 Headwall Concrete LS. 1 $75,000.00 $75,000.00
CO 4-4 Gabion Baskets/Erosion Matting LS. 1 $54,850.00 $54,850.00
CO 4-5 Backfill/Fine Grading LS. 1 $7,000.00 $7,000.00
CO 4-6 Existing Irrigation System Repair/top soil/sod(Gill Yard) LS. 1 $2,500.00 $2,500.00
CO 4-7 Temporary Pavement Restoration at Ruby Hotel TN 300 $20.00 $6,000.00
TOTALS: $16 1 0 90
Pa cc 3 of 3
cN Contract Quantity Adjustment/Change Order
rev,01/16 ���
Project Name: Northeast Downtown RevitaIization
Quan.Adj./Change Order No.: 4
Quantity Adjustment Data
Contract
Time
Bid Item# Item Description Unit Adjustment
p Qty. Unit Price Amount
- tnavqi
84 8-inch DI CL350 water line,open cut,all depths LF. 200 $100.00 $20,000.00
87 Ductile Iron fittings,complete in place Tn 2 $7,500.00 $15,000.00
Install or reconnect lateral water service to existing or replace pipe
88 1-1/2 or 2-inch water service to city meter Ea. 11 $3,500.00 $38,500.00
90 Wet connection to water main,8-inch Ea. 8 $1,700.00 $13,600.00
162 Barricades,signs and traffic handling Mo 2 $2,000.00 $4,000.00
Service Pipe, 6-inch SDR-26 class 160 wastewater line,open cutall
204B depths,complete in place LF. 450 $154.00 $69,300.00
CO3-2 Pipe burst existing 6-inch wastewater with 8-inch HDPE LF. 3 $93.75 $281.25
CO3-3 Reconnect to existing wastewater Service Lateral Ea. 1 $1,500.00 $1,500.00
CO3-4 Wastewater Service Saddles Ea. 1 $125.00 $125.00
$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 162 306.25 0
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
l of l
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,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. 2021-799571
Cash Construction Company,Inc is MasTec North America
Pflugerville,TX United States Date Filed:
Name of governmental entity or state agency that is a party tot the contract for which the form is 09/08/2021
being filed.
City of Round Rock,Texas 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 under the contract.
000000
NorthEast Downtown Revitalization-NorthEast Downtown Utility Improvements
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party. ❑
X
6 UNSWORN DECLARATION
My name is _Michael Stevens _, and my date of birth is __
My address is 217 Kingston Lacy Boulevard Pflugerville TX 78660 ,_US.
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in TraylS County, State of Texas ,on the Blh_day of September,20 21
(month) (year)
Signature of authorized gent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos. 1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos. 1,2,3,5,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. 2021-799571
Cash Construction Company, Inc is MasTec North America
Pflugerville, 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 09/08/2021
being filed.
City of Round Rock, Texas Date Acknowledged:
09/08/2021
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
NorthEast Downtown Revitalization-NorthEast Downtown Utility Improvements
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party.
X
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.ethics.state.tx.us Version V1.1.191b5cdc