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CM-10-02-046TEXAS DEPARTMENT OF TRANSPORTATION CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 07 Third Party Funding Notification Sheet This form is used when the subject change order involves funding by a source other than TxDOT/U.S. DOT, and involves third parties who are providing funding under an Advance Funding Agreement or Donation Agreement. 1. Outside funding provided by: City of Round Rock (Outside Entity's Legal Name) 2. Type of outside funding agreement for this change: r Existing r Amended [Check one] r New 3. Indicate the type and amount of funding: I— Fixed Price (Lump Sum) (Estimated Amount $5,995.29 (X Actual Cost (a) Contract Items (Bid Items): $5,995.29 (b) E&C*: (a) x 3.00 = / 79. B enter % (c) Indirect Cost**: (a + b) x = 0 enter % TOTAL ' CCSJ: 2211-02-015 Project: STP 2005(921) Highway: FM 1460 County: Williamson District: Austin Contract Number: 05093202 Use as needed: 1 hereby acknowledge notification of the modifications covered by this Change Order. Date By Type Typed/Printed Title • The percentage (%) for E&C (Engineering and Contingencies) charges varies from project to project depending on the contract amount of the project. Projects with a higher contract amount will have a lower rate of E&C charge. For a specific project, E&C rate (%) can be derived from the cost of "Engineering and Contingencies" in the "Estimated Cost" of the project. ** Use the statewide district rate as established by Finance Division each year. This line 3(c) is for Service Project only, unless otherwise specified in the Advance Funding Agreement. See Stand Alone Manual Notice 98-2 for instructions. Funding for this Change Order has been arranged: TxDOT Representative Typed/Printed Name: Date TXDOT Form 2146-AFA (Rev.7/2007) Page 1 of 1 W1-'10-02.-046 0 § 0 REPORT DATE: CHANGE ORDER NBR. E 0//\ o . - a _ u- 0 o c / 2 2 D / ; / / 2 0 L_ ° a, / R j N 0 P f NEI L❑ WILLIAMSON AREA ENGINEER: AREA NUMBER: DESCRIPTION: § § SECONDARY REASON(S): 0 z / a <z ce o / o D \ 0 \ F \ / aii© =J,. 0 \ \ - - / = a / \\\\\\ //§ CV m 0__ o $ m_< CONTRACT ID: § n. CONTRACT: AWARD AMOUNT: PROJECTED AMOUNT: CONTRACTOR: CO AMOUNT: >- \ 3RD PARTY AMOUNT: APPRV LEVEL: \ c �> 0 �/ ° // U f z § cas k ( < ( 0\ u/ S3 = I = o1- k\ Z \ ® E o 0 • - w c < oes 0 / —a oc \—0R3 0 7 / 0 k/ 7a /) \§ CO \( \ w)�\k CL k . / § a a < E / 3 ® -00 2 G e m 0 \ I) w) _c 2f } 0) /\ 0 E / « 2 mt & pQ f° 0 0 20 u \& �$ o - c o & z 0- &{ 0 \Q F- a) Ti (\ §/\ fCt 0)- }£ )}) cO x°0 Eo. \} 1- \ t o 0) m2$ \£D) �0/ ®// ADDITIONAL TIME NOT NEEDED \0 \\ C 713 /\ 10 0 - /\ aO \\ \E /} \\ ca Ea o. \o( as co \/ CO cO CC 1i) 7/ {) ca CO cr3 // f B 46 oo\ o2> If. as ca c #• \/ THE CONTRACTOR U DISTRICT ENGINEER: 0 0 DIRECTOR, CONSTRUCTION DIVISION: TYPED/PRINTED NAME: 0 0 AED For Eng. Operations: TYPED/PRINTED TITLE: 0 0 AREA ENGINEER: E 0 / AREA ENGINEER'S SEAL: I-- O N N Z U O p v N 2 F („ a) a co co 0.o W F N W Z d m -a- CHANGE ORDER NBR. CONTRACT ID CONTRACT ITEMS PROJECT NBR w I- Z D a DESCRIPTION a m h m 0 0 0 0 0 0 Z o O w a n H o a a 0 N- Z O 0 0 0 CV 0 Z o o N U W L r W Y Y CN o o N O Z a a CC 0 U N (n W 0 0 0 f 0 CO O Fwp o - U rn W w Z W v J F o O F- a' Q m Z ADDTL CO DESCR 1 F p Z U O =N Q w F- za O C7 U 2 H w F- 0. a F Z D DESCRIPTION PROJECT NBR 0 0 ui 0 0 0 0 0 0 0 CC 0 U cn (o W 0 0 WCV C CO 0 F U rn w Z w W co J O F LC U 2 0 ADDTL CO DESCR 1 CHANGE ORDER AMOUNT DATE: February 17, 2010 SUBJECT: City Manager Approval — February 19, 2010 ITEM: Consider executing Construction Contract Change Order No. 7 with TxDOT for the FM 1460 expansion project. Department: Transportation Services Staff Person: Thomas E. Word, P.E., Chief of Public Works Operations Justification: This Change Order No. 7 reimburses the contractor for restocking the Design 7 temporary pipe that was eliminated in Change Order No. 4. This also compensates the contractor for providing message boards and light plants for additional waterline work at Agarita Trail. 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: $6175.15 Source of funds: 4B — Round Rock Transportation Development Corporation Construction Outside Resources (if applicable): TxDOT Cash Construction Company, Inc. Public Comment (if applicable): N/A UPDATED APRIL 2008 ,0.1909 Request for City Council/City Manager Action L11 City Council GM 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: Bit Stablein Project Coordinator: Tom Word, P.E. Assigned Attorney: Stephan Sheets City Council or City Manager Approval Date: Agenda Wording FEB Tag A: #: e_44 -)O -o2 014 Le Tag Original Documents Received: Project Name: FM 1460 Expansion ContradorNendor: TxDOT Funding Source: RR Trans Dev Corp Construction Additional funding Source: Amount: $ Account Number. 2/19/2010 6,175.15 Consider executing Construction Contract Change Order No. 7 with TxDOT for the FM 1460 expansion project. Finance Information Is Funding Required? Initial Construction Contract Construction Contract Amendment Change Order Change in Quantity Initial Professional Services Agreement Supplemental Professional Service Agreement Purchasing/Service Agreement Purchase Order Item(s) to be purchased Yes C7 No [O h 1 EIUnforeseen Circumstances Other (Please clearly identify action below) Amount $ 6,175.1$ !NAr F WA Approved as El El 00 Finance/CIP FinancelAcct Purchasing Budget Date Date Date Date APPROVALS (to be completed ONLY by Finance) Ropro,jai R Approved I :Ir Finance Director :7 i 4;4J:royals e beer n r d, txoase rorward the RFA..Wfie she 61. Dack ierortreed oignais r: City Secreta/y, Sara White. ITEMS WIi.L NOT BE PLACED ON THE COUNciL AGE r r i ^TOUT FINANCE ANO E.. GAL APPROVAL. PRIOR TO SUBMISSION Required for Submission of ALL Ctty Co ncil and City Manager Items Project Mgr. Signature: Dept. Director Signature: *City Attorney Signature: City Manager Signature: Date Date: Date: Date: Date: ,2-1/ — �v /1/, 10 d 'I-1-rO 'City Attorney signature is required for at items. REVISED 2/11/2010 10 19 09 Request for City CounciUCity Manager Action ® City Council ECE1 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: Bit 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: FM 1460 Expansion ContractorNendor TxDOT Funding Source: RR Trans Dev Corp Construction Additional funding Source: Amount: $ Account Number: 2/19/2010 6,175.15 Consider executing Construction Contract Change Order No. 7 with TxDOT for the FM 1460 expansion project. Finance Information iJ EJ Is Funding Required? Yes 0 No n Initial Construction Contract Construction Contract Amendment # Change Order # 7 Change in Quantity [}Unforeseen Circumstances Initial Professional Services Agreement Supplemental Professional Service Agreement g Purchasing/Service Agreement Purchase Order Item(s) to be purchased Other (Please clearly identify action below) Amount $ 6,175.15 FINANCE N/A Approved o cJ E ED ED Finance/CIP L Olsen Finance/Acct E. Wilson Purchasing EE Bowden Budget P. Bryan APPROVALS (to be completed ONLY by Finance) Final Finance Approval Required Date 2/16/2010 Date 2/16/2010 Date 2/16/2010 Date 2/16/2010 iX APPS ESW for C. Delaney 2/17/2010 Finance Director Date 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. Required for Submission of ALL City Council and City Manager Items Project Mgr. Signature: Date: Dept. Director Signature: Date: *City Attorney Signature: Date: City Manager Signature: 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: PW/Transportation Project Mgr/Resource: tail! Stab!ein nCouncil Action: ORDINANCE Agenda Wording Project Name: FM 1460 Expansion ContractorNendor: TxDOT n RESOLUTION f}City Manager Approval CMA Wording Consider executing Construction Contract Change Order No. 7 with TxDOT for the FM 1460 expansion project. Attorney Approval ['Attorney Date Notes/Comments O:1wd ox1S C C I n ts10199170391 M I S 0100183131. X L S Updated 6/3/08