Contract - APAC-Texas, Inc. - 5/12/2016Page 1 of 3
Contract Quantity Adjustment/ Change Order
HOUND POCK TEAS
rev, 01/16
Department: Transportation
Project -
Name: 2014 Street Maintenance Program (Overlay) Date: 3/17/16
City Project Change Order/Quantity
ID Number MNT14 Adjustment No. 2
Vendor APAC-Texas, Inc 1 Chisholm Trail Round Rock, Texas 78681 512-861-7100
Company Name Address Phone No.
Justification
Quantity Adjustment/Change Order # 2 is a final quantity adjustment to reflect actual project quantities for this project. These adjustments are
the result of additional areas Found during the pavement repairs and overlay for the 2014 Street Maintenance Program (Overlay).
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:
Amount
-$1,073,079.61
-$1.073.079.61
$51,600.00
1%
$24,278.00
1%
$75,878.00
2%
$4,252,974.64
-$997,201.61
Original Contract Time: 275 days
Time Adjustment by previous Quan. Adj./Change Order: 2
Time Adjustment by this Quan. Adj./Change Order: 11
New Contract Time: 288 Days
�� Submitted for
Prepared
l-
Prepared By: / Randy Crum, Project Manager Senior, City of Round Rack 3/18/16
Sinnatrrr�� Printed Name, Title, Company Date
City Project
Manager:
?nature
Mayor/City ,^
Manager
Signature
1Z �iil�l� - _2-4n
Printed Name, Title, Company
Randy Crum, Project Manager Senior,
Printed Name, Title
Printed Name, Title
ound Rock
Y -- C -M -Zoi16
Date
.124
.',,_ Contract Quantity Adjustment/ Change Order
ROUND POCK TEXAS
rev, 01/16
Project Name: 2014 Street Maintenance Program (Overlay)
Quan. Adj./Change Order No.:
['Fianna nrrlar Dnfn
Page 2 of 3
Item # Item Description Unit Qty. Unit Price
Amount
Contract
Time
Adjustment
(Days)
901 Pavement Repair LS 1 $9,250.00
$9,250.00
1
902 Crack fill LS 1 $15,028.00
$15,028.00
10
$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
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS: "� 24,278.00+
1..._
Page 3 of 3
Contract Quantity Adjustment/Change Order
HOIlNO BOCK 7D(AS
rev, 01/16
Project Name: 2014 Street Maintenance Program (Overlay)
Quan. Adj./Change Order No.
Bid item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
1
Machine -Laid Type D Overlay
TON
-2950.639318
$88.00
-$259,656.26
2
Machine -Laid Type. FOverlay
TON
-115.1176
$100.00
-$11,511.76
3
Pavement Repair
TON
-8144.157843
$102.00
-$830,704.10
4
5
6
Type D HMAC Spot Level -Up
Edge Milling
Surface Milling
TON
SY
SY
-57.75
0
0
$120.00
$1.60
$1.60
-$6,930.00
$0.00
$0.00
7
8
Remove/Replace Concrete Curb & Gutter
Remove/Replace Concrete Driveway
LF
SF
-125.4834426
4550.71428
$61.00
$21.00
-$7,654.49
$95,565.00
9
10
11
Remove/Replace Reinforced Concrete
Sidewalk
Manhole Adjustment
Valve Can Adiustment
SF
EA
EA
-1532.235294
-23.2928176
-3.45945945
$17.00
$905.00
$710.00
-$26,048.00
-$21,080.00
-$2,560.00
12
Reinforced Concrete Sidewalk Ramp
EA
-0.83333333
$3,000.00
-$2,500.00
$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 3
TOTALS: _$1.073.079.61
Forms provided by Texas Ethics Commission www.ethics.state.tx.us version V1.0.1021
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1041
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.
2016-50425
APAC-Texas, Inc
Cedar Park, TX United States
Date Filed:
05/05/2016
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 Rack
Date Acknowledged:
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 services, goods or other property to be provided under the contract.
2014 Street Maint Overlay
PAVING, STREET CONSTRUCTION
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest (check applicable)
Controlling
Intermediary
Oldcastle Materials
TX United States
X
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.
JACQUELIN NICK01F CARPENTER
4
-'apt' rr- r1oicii Public, State of Texas
Con-21J17
Signature of authorized agent of contracting business entity
t4olafy ID 1296157 57 g � g tY
AFFIX NOTARY STAMP 1 SEAL ABOVE
Sworn to and subscribed before me, by the said f;0 1PJWY-5 this the day of ,
20 '— O to certify which, witness my hand and seal of office.
ol
ignature of officer administering oath Printed name of officer administering o th Title of officer adm istering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us version V1.0.1021
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
10f1
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:
2016-50425
Date Filed:
05/05/2016
Date Acknowledged:
05/06/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
APAC-Texas, Inc
Cedar Park, 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 services, goods, or other property to be provided under the contract.
2014 Street Maint Overlay
PAVING, STREET CONSTRUCTION
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
OLDCASTE MATERIALS
TX United States
X
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.u.luz1