CM-12-06-108ROUND ROCK, TEXAS
PURPOSE. PASSION. PROSPEROY
Item Caption:
Cift4-12-OU -(08
RECEIVED
JUN 13' 2012`
CI Manager Approval Form
Consider executing Quantity Adjustment/Change Order #1 with Mario L. Carlin Management, LLC for the
Rock Hollow Park Trail Improvement Project.
Approval Date: June 15, 2012
Department Name: Parks and Recreation Department
Project Manager:
David Buzzell, Park Development Manager
Assigned Attorney: J. Kay Gayle
Item Summary:
Change Order #1 for a concrete picnic table pad in order to facilitate improved ADA access to the park amenity.
No. of Originals Submitted: 1
Project Name:
Cost: $800.00
Source of Funds:
Rock Hollow Park Trail Improvement Project
Parks Improvement & Acquisition Fund
Source of Funds (if applicable): Select Source Fund
Account Number: PKO1RHLW
Finance Director Approval: LO for C. Delaney
Department Director Approval:
Date: 6-12-12
Date: 6.-43 -it.,
**Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. **
CIP I f I I Budget
N/A OK
❑�ElN/A OK
Purchasing
❑ ❑
N/A OK
Accounting I I
N/A
OK
ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL
REV. 6/20/11
---/C71°:--ausiumat
rev, 06/12
Department: PARD
Contract Quantity Adjustment/Change Order
Project Rock Hollow Park Trail Improvement
Name: Project
City Project
ID Number PKO1RHLW
Justification
Page 1 of 3
Date: 6/11/12
Change Order/Quantity
Adjustment No. 1
Additional concrete material needed.
SUMMARY
Original Contract Price:
Previous Quantity Adjustment(s):
This Quantity Adjustment:
Total Quantity Adjustment(s):
Total Contract Price with Quantity Adjustment(s):
Previous Change Order(s):
This Change Order:
Total Change Order(s) To Date:
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s) Plus Change Order(s)]:
Difference between Original and Adjusted Contract Prices:
Original Contract Time:
Time Adjustment by previous Quan. Adj./Change Order:
Time Adjustment by this Quan. Adj./Change Order:
New Contract Time:
Prepared By:
Si.nature
For Contractor:
Printed Contractor Company Name:
Amount
0/0 Change
$0.00
$800.00
$800.00
0.00
0.01
0.01
$73,386.00
$800.00
120 Calendar Days
0 Calendar Days
0 Calendar Days
120 Calendar Days
Aileen Dryden, Park Development Specialist
Printed Name, Title
Signature
Printed Name, Title
Date
6- /Y( 7o/2,
Date
For City
Round Roc
Signature
Printed Name, Title
Date
rev. 06/12
Contract Quantity Adjustment/Change Order
Project Name: Rock Hollow Park Trail Improvement Project
Quan. Adj./Change Order No.: 1
Change Order Data
Page 2 of 3
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
(Days)
1
Concrete Picnic Pad
LS
1
$800.00
$800.00
$0.00
$0.00
0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.o0
$0.00
$0.0o
$o.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS:
$800.00
0