Contract - Lone Star Paving - 3/10/2016-? ROlINO ROCK TEICA!
rev, 06/15
Department:
Project
Name:
City Project
ID Number
Justification
Contract Quantity Adjustment/ Change Order
Transportation
2015 Street Maintenance Program (Pavement Repairs)
MNT16
Page I of 3
Date: 1/5/16
Change Order/Quantity
Adjustment No. i
.ontract Quantity Adjustment/Change Order #1 is a final quantity adjustment for the project closeout. These adjustments are the result of
additional areas found during the pavement repairs and overlay for the 2015 Street Maintenance Program (Pavement Repairs) Project and
leducts to reflect actual quantities.
SUMMARY
Amount
% Change
Original Contract Price:.
$598,150.00
Previous Quantity Adjustment(s):"
This Quantity Adjustment:
$130,232.20
Total Quantity Adjustment(s):
$130,232.20
Total Contract Price with Quantity Adjustment(s):
$728,382.206"
728,382.206
o
,
Previous Change Order(s):
0.00
This Change Order:
-$3,747.80
-0.01
Total Change Order(s) To Date:
-$3,747.80
-0.01
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s) Plus Change Order(s)]:
$72,1,634.40[".
-^11:
-M -
Difference between Original and Adjusted Contract Prices:
$126,484.40
Original Contract Time:
Time Adjustment by previous Quan. Adj./Change Order:
Time Adjustment by this Quan. Adj./Change Order:
New Contract Time:
0
Signature Printed Name, Title, Company Date
Contractor:
ature Printed Name, Title, 6ompany D e
City Project
Manager: _ Randy Crum, Project ManagerSenior, City Of Round Rock_ 1/13/16
Printed Name, Title Date
Mayor/CityL'
Manager G
Signature Printed Name, 'llitih Date
Contract Quantity Adjustment/ Change Order
� ROUNG ROCK TEXAS
rev, 06/15
Project Name: 2015 Street Maintenance Program (Pavement Repairs)
Quan. Adj./Change Order No.:
Chance Order Data
Page 2 of 3
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
Da s
, a
NOW
5
Reflectorized T(-1 Thermoplastic
Pavment Markings (4" Broken -Yellow)
LF
-30
$2.00
-$60.00
8
Reflectorized TY -1 Thermoplastic
Pavment Markings (12" Solid -White)
LF
-17
$3.40
-$57.80
10
Reflectorized TY -1 Thermoplastic
Pavment Markings (Word -White)
EA
-3
$120.00
-$360.00
11
Reflectorized TY -1 Thermoplastic
Pavment Markings (Arrow -White)
EA
-3
$90.00
-$270.00
12
Manhole Adjustment
EA
-1
$600.00
-$600.00
13
Valve Can Adjustment
EA
-4
$300.00
-$1,200.00
14
Erosion Control
LS
-1
$1,200.00
-$1,200.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS,
$3747.80
0
Page 3 of 3
Contract Quantity Adjustment/Change Order
ROUNO ROCKT[XAS
rev, 0611$
Project Name: 2015 Street Maintenance Program (Pavement Repairs)
Quan. Adj./Change Order No.:
nnnntity Adiustment Data
�'-''.'„»=`�.�..r- y>'-vz�,.�-� v'c- .. �:. �." � ..r"°i ,r'-.----�'.:. �' E` ...t '.-.,wy � .�� "`�' •' �`�""" 'F'c 1"y� zrc..�^a�. �:�- �'`=,
Contract
Time
Adjustment
Bid Item # Item Description Unit Qty. Unit Price Amount
1 Machine -Laid Type C-HMAC 2.5" Ton 480 $165.00 $79,200.00
2 Pavement Repair -(RAP)
ton
14
$140.00
$1,960.00
3 Surface Milling
SY
2005
$17.00
$34,085.00
Reflectorized TY -1 Thermoplastic
4 Pavement Marking (4" Solid Yellow)
LF
2
$2.80
$5.60
Reflectorized TY -1 Thermoplastic
6 Pavement Markings (4" Broken -White)
LF
370
$2.00
$740.00
Reflectorized TY -1 Thermoplastic
7 Pavement Markings (8" Solid -White)
LF
502
$4.80
$2,409.60
Reflectorized TY -1 Thermoplastic
9 Pavement Markings (24" Solid -White)
LF
1740
$6.80
$11,832.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS: $130,232.20 0
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
loft
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE. USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2016-14403
Date Filed:
02/17/2016
Date Acknowledged:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Asphalt Inc„ LLC dba Lone Star Paving Company
Austin, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock
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 goods or services to be provided under the contract.
Vender ID 60776
Paving and Asphalt Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest (check applicable)
Controlling
Intermediary
Tyler Wheeler Heritage Trust
Austin, TX United States
X
Kaitlin Wheeler Heritage Trust
Austin, TX United States
X
Patrick Wheeler Heritage Trust
Austin, TX United States
X
Nolan Wheeler Heritage Trust
Austin, TX United States
X
Preferred Materials, Inc
Round Rock, TX United States
X
Asphalt Inc Employee Investments, LLC
Austin, TX United States
X
Spinn, Stephen
Austin, TX United States
X
Wheeler, John
Austin, TX United States
X
Cabaza, Aaron
Austin, TX United States
X
Carroll, Ben
San Antonio, TX United States
X
Knox, Allen
Austin, TX United States
X
Playfair, Thomas
Spicewood, TX United States
X
Ohlendorf, Ryan
Buda, TX United States
X
Lundquist, Dean
Austin, TX United States
X
Hayden, Roger
San Antonio, TX United States
X
Duenez, Ronnie
Austin, TX United States
X
Carroll, Brian
Temple, TX United States
X
Forms provided by Texas Ethics Commission m% v. ethics. state. tx.us Version V1.0.34944
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
2of2
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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2016-14403
Asphalt Inc., LLC dba Lone Star Paving Company
Austin, TX United States
Date Filed:
02/17/2026
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock
Date Acknowledged:
g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the goods or services to be provided under the contract.
Vender ID 60776
Paving and Asphalt Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest (check applicable)
Controlling
Intermediary
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
`f THERESA SANCOM
•r 't My Notary 10 # 7556824
ExpiresG__---------
April 16.
`:� , ;a 2020
Signature of auth ized agent of contracting business entity
C
AFFIX NOTARY STAMP! SEAL ABOVE TS3
Sworn/to and subscribed before me, by the said�A t �f� lQitl i r) Q , this the day of
20 to certify which, witness my hand and seal of office.
Sig .ture f officer administering oath Printed name of officer administering oath Title of officer ai&ninistering oath
Fnrms nrovided by Texas Ethics Commission vAvw. eth ics.state.tx.us Version V1.0.34944
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
1of2
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2016-14403
Date Filed:
02/17/2016
Date Acknowledged:
02/29/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Asphalt Inc., LLC dba Lone Star Paving Company
Austin, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock
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 goods or services to be provided under the contract.
Vender ID 60776
Paving and Asphalt Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest (check applicable)
Controlling
Intermediary
Tyler Wheeler Heritage Trust
Austin, TX United States
X
Kaitlin Wheeler Heritage Trust
Austin, TX United States
X
Patrick Wheeler Heritage Trust
Austin, TX United States
X
Nolan Wheeler Heritage Trust
Austin, TX United States
X
Preferred Materials, Inc
Round Rock, TX United States
X
Asphalt Inc Employee Investments, LLC
Austin, TX United States
X
Spinn, Stephen
Austin, TX United States
X
Wheeler, John
Austin, TX United States
X
Cabaza, Aaron
Austin, TX United States
X
Carroll, Ben
San Antonio, TX United States
X
Knox, Allen
Austin, TX United States
X
Playfair, Thomas
Spicewood, TX United States
X
Ohlendorf, Ryan
Buda, TX United States
X
Lundquist, Dean
Austin, TX United States
X
Hayden, Roger
San Antonio, TX United States
X
Duenez, Ronnie
Austin, TX United States
X
Carroll, Brian
Temple, TX United States
X
Forms nrnvided by Texas F_thics Commissinn www. ethics. state.tx. us Version V1.0.34944
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
2 of 2
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2016-14403
Date Filed:
02/17/2016
Date Acknowledged:
02/29/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Asphalt Inc., LLC dba Lone Star Paving Company
Austin, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock
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 goods or services to be provided under the contract.
Vender ID 60776
Paving and Asphalt Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest (check applicable)
Controlling
Intermediary
5
Check only if there is NO Interested Party. ❑
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
Version V1.0.34944