CM-10-02-045rev. 1/10
Contract Quantity Adjustment/Change Order
Department: Transportation Administration
Project
Name:
Traffic Signal -- Via Sonoma at Gattis School Road
City Project
ID Number: TX05TRFSIG
Justification
Page 1 of 3
Date:
Change Order/Quantity Adjustment
No.
2/10/2010
1
Quantity overran expected quantity
SUMMARY
Original Contract Price:
Total Contract Price with Quantity Adjustment(s):
Previous Change Order(s):
This Change Order:
Total Change Order(s) To Date:
Previous Quantity Adjustment(s):
This Quantity Adjustment:
Total Quantity Adjustment(s):
Original Contract Price Plus Change Order(s) Plus
Quantity Adjustment(s):
Original Contract Time:
Contract Time Prior to this Change Order:
Contract Time with All Approved Change Orders:
Signatures and Approvals
Prepared by: C /2/4 '„ lie+fr -PJ e , H
signature Printed Na Title and Company
Contractt
PP
City staff
Approval:
City Official
Approval:
Signature
gi ()Si
Signature
ature
Amount
$136,779.00
$140,006.20
0/0 Change
0.00%
$0.00 0.00%
$0.00 0.00%
$3,227.20
$3,227.20
$140,006.20
Z lc--�c�1c�
C i t/� -( i r�
Date
LKI111+ecl(= r —P( ! Ley►it
s\(._1 1-1(:)C'
Date
Printed Name; Title and Company
(1:11\ %mak c
Printed Name and Title Date
\OLPPri�nted .ntName and Title ui.P.E. t1(lc�ur� 2- 1�-
Date Lo
rev. 01/10
Contract Quantity Adjustment/Change Order
Change Order Data
Page 2 of 3
Bid Item#
Item Description and Change
Unit
Qty.
Unit Price
Amount
Contract Time
Adjustment
(Days)
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$o.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$o.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$o.00
o
$0.00
$o.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$o.00
o
$0.00
$o.00
o
$0.00
$o.00
o
$0.00
$o.00
o
$o.00
$o.00
o
$0.00
$0.00
o
$0.00
$0.00
o
$0.00
$o.00
TOTALS:
$0.00
0
rev. 01/10
Contract Quantity Adjustment/Change Order
uantity Adjustment Data
Page 3 of 3
TOTALS:
$3,227.20
0
Bid Item#
Item Description and Change
Unit
Qty.
Unit Price
Amount
Contract Time
Adjustment
(Days)
SGS -00G4
SGS -00G5
SGS -00G7
SGS -00G8
SGS -00G9
SGS -0G19
SGS -0G20
SGS -0G21
SGS -0G22
SGS -0G34
COND (PVC SCH 40) 2IN
COND (PVC SCH 40) 3 IN
ELC (NO 6) BARE
ELC (NO 6) INSUL
ELC (NO 8) BARE
MULTI SIG CBL (2CON/12 AWG)
MULTI SIG CBL (3CON/12 AWG)
MULTI SIG CBL (4CON/12 AWG)
MULTI SIG CBL (5CON/12 AWG)
VIVDS (COMM CABLE) COAXIAL
LF
LF
LF
LF
LF
LF
LF
LF
LF
LF
18
$12.00
$216.00
22
$17.00
$374.00
30
$1.60
$48.00
60
$2.00
$120.00
389
$1.30
$505.70
433
$1.30
$562.90
222
$1.80
$399.60
20
$2.30
$46.00
35
$5.00
$175.00
195
$4.00
$780.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.0o
0
$0.00
$0.00
0
$0.00
$0.00
0
$0.00
$0.00
TOTALS:
$3,227.20
0
DATE: February 17, 2010
SUBJECT: City Manager Approval — February 19, 2010
ITEM: Consider executing Quantity Adjustment/Change Order No. 1 with Austin Traffic
Signal for the Traffic Signal — Via Sonoma at Gattis School Road Project.
Department: Transportation Services
Staff Person: Thomas E. Word, P.E., Chief of Public Works Operations
Justification:
Due to unforeseen items that are required to complete the work pertaining to the installation
of the traffic signal on Via Sonoma at Gattis School Roads, the combined Quantity
Adjustment/Change Order No.1 is required.
Strategic Plan Relevance:
26.0 Construct major elements of the transportation and mobility system as approved by
Council in the Master Transportation Plan
Funding:
Cost: $3,227.20
Source of funds: 4B — Round Rock Transportation Development Corporation Construction
Outside Resources (if applicable):
Austin Traffic Signal
Public Comment (if applicable):
N/A
UPDATED APRIL 2008
10 1909
Request for City Council/City Manager Action
[u1 City Council [i?] City Manager
Submit completed form for all City Manager and City Council approvals.
Received:
Tag #:
Ori, inal Documents Received:
Department Name: Transportation Services Project Name: Traffic Signal - Via Sonoma at Gattis School Road
Contact Person: Chaz Gordon / Kathy Michna
Project Mgr/Resource: Bill Stablein
Project Coordinator. Tom Word, P.E.
Assigned Attorney: Stephan Sheets
City Council or City Manager Approval Date:
Agenda Wording
ContractorNendor: Austin Traffic Signal
Funding Source: RR Trans Dev Corp Construction
Additional funding Source:
Amount: $
Account Number:
2/19/2010
3,227.20
Consider executing Quantity Adjustment/Change Order No. 1 with Austin Traffic Signal for the Traffic Signal -- Via Sonoma at Gattis School Road project.
Finance Information
Is Funding Required?
Yes C) No
Initial Construction Contract
Construction Contract Amendment
Change Order # t
Change in Quantity EjUnforeseen Circumstances
Initial Professional Services Agreement
Supplemental Professional Service Agreement
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
Other (Please clearly identify action below)
Amount
$ 3,227.20
I"i'' E.
N/A Approved
l
D El
Finance/CIP
Finance/Acct
Purchasing
Budget
Date
Date
Date
Date
APPROVALS
(to be completed ONLY by Finance)
Approqat Retuues.
Approved
Finance Director Date
Once approvals have been obrafned please totwacd Te':: A L__,e sheet. tack ,;,a /prop-oat/0o ar d offewals to City Secretary, Sara White,
ITEMS WILL NOT of PLACED ON THE CCL Nc!t. Ar.NDA*THOU"( tLNANCF AND LEGAL APPROVAL PRIOR TO SUBMISSION_
Required for Submission of ALL City Council and City Manager Items
Project Mgr. Signature:
Dept. Director Signature:
'City Attorney Signatur
City Manager Signature:
M1✓�.� /t aw_
Date:
Date:
Date:
Date:
2-19-10
2- 19-
*CRY Attorney signature is required for an hems.
REVISED 2/11/2010
10 19 09
Request for City Council/City Manager Action
® City Council fro City Manager
Submit completed form for all City Manager and City Council approvals.
Department Name: Transportation Services
Contact Person: Chaz Gordon / Kathy Michna
Project Mgr/Resource: Biu Stablein
Project Coordinator: Tom Word, P.E.
Assigned Attorney: Stephan Sheets
City Council or City Manager Approval Date:
Agenda Wording
For Administration Use ONLY
Received:
Tag #:
Original Documents Received:
Project Name: Traffic Signal - Via Sonoma at Gattis School Road
ContractorNendor: Austin Traffic Signal
Funding Source: RR Trans Dev Corp Construction
Additional funding Source:
Amount: S
Account Number:
2/19/2010
3,227.20
Consider executing Quantity Adjustment/Change Order No. 1 with Austin Traffic Signal for the Traffic Signal -- Via Sonoma at Gattis School Road project.
Finance Information
Is Funding Required?
Initial Construction Contract
Construction Contract Amendment
Change Order
[]Change in Quantity
Initial Professional Services Agreement
OSupplemental Professional Service Agreement
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
Yes O J No n
u
9 1
EX Unforeseen Circumstances
Other (Please clearly identify action below)
Amount
$ 3,227.20
FINANCE
N/A Approved
E
FinancelClP L Olsen
Finance/Acct E. Wilson
Purchasing EE Bowden
Budget P. Bryan
APPROVALS
(to be completed ONLY by Finance)
Final Finance Approval Required
Approved
Date 2/16/2010
Date 2/16/2010
Date 2/16/2010
Date 2/16/2010
�x
ESW for C. Delaney
Finance Director
Once approvals have been obtained, please forward the RFA, blue sheet, back up information and originals to City Secretary, Sara White.
ITEMS WILL NOT BE PLACED ON THE COUNCIL AGENDA WITHOUT FINANCE AND LEGAL APPROVAL PRIOR TO SUBMISSION.
2/17/2010
Date
Required for Submission of ALL City Council and City Manager Items
Project Mgr. Signature:
Dept. Director Signature:
'City Attorney Signature:
City Manager Signature:
Date:
Date:
Date:
Date:
*City Attorney signature is required for all items.
REVISED 2/17/2010
LEGAL DEPARTMENT APPROVAL FOR CITY COUNCIL/CITY MANAGER ACTION
Required for Submission of ALL City Council and City Manager Items
Department Name: PWlTransportation
Project Mgr/Resource: Bill Stablein
®Council Action:
I 1
ORDINANCE
Agenda Wording
Traffic Signal -Via Sonoma at Gattis School
Project Name: Road
Contractor/Vendor: Austin Traffic Signal
n RESOLUTION
City Manager Approval
CMA Wording
Consider executing Quantity Adjustment/Change Order No. 1 with Austin Traffic Signal for the Traffic Signal - Vial Sonoma at
Gattis School Road Project.
Attorney Approval
Attorney
Notes/Comments
Date
r
O:\wdox\SCCInts\0199\6054.11M IS C100183135.XLS
Updated 6/3/08