CM-05-01-003iril06-Orte3
Request City Council/City ManY
q ger Action
Please submit this form when placing items on the council agenda or when submitting an item to the City Manager for approval.
Department:
Contact Person: Latha Kumar Council Meeting Date:
Project Name: Various Round Rock West & Blue Tubing 'K' Funding Source:
ContractorNendor Name: Nelson Lewis Incorporated
Amount:
Engineering & Development Services Project Manager/Resource: Alysha Girard
tit
Assigned Attorney: a'0D 1 Go M -v aat84 8• tpO
$24,722.80 (contract, agreement,amendment,change order, purchase order,etc.)
Is Funding Required? Yes
Council Agenda Item Yes
Submission to City Manager - Yes
x
x
No
No
No
x
1Lf h t:l5
(see required signatures below before submission to the City Manager)
0
Initial Construction Contract
Construction Contract Amendment #_
❑ Change Order # 2
n Change in Quantity
n Unforeseen Circumstances
❑ Initial Professional Services Agreement
❑ Supplemental Professional Svcs. Agr. #
❑ Purchasing/Service Agreement
❑ Purchase Order
Item(s)to be purchased:
Amount
$24,722.80
❑ Other (Please clearly identify action on lines below)
Agenda Wording: Consider an action by the City Manager to execute Change Order No. 2 with Nelson Lewis, Inc. for
the Various Round Rock West Street Project. Unforeseen Circumstance and Final Quantity Adjustments.
This change order calls for a net increase of $24,722.80.
1 -/q -as
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For Submission to Cit - na . er Ord
Project Mgr. Signature:
Dept. Director Signature:
City Attorney Signature:
City Manager Signature:
Date: I2 TA j s
Date: i`i 2.10
S
Date: ''may as
Date: /-/ t>1;-
*
Legpproval is required for all items requesting City Manager's approval.
Finance Approval
❑ lFinance -Date and Signature: L. Olsen 1-12-05
X❑ Purchasing -Date and Signature: N/A HB 1-10-05
X❑ Budget -Date and Signature: N/A CYD 1/10/2005
g/administration/cmgr-council action.sls 11-1-04