Contract - Capital Excavation - 3/9/2017 Page 1 of 3
Contract Quantity Adjustment/Change Order
ROUND ROIX TEXAS
rev,06/15
Department: Transportation
Project
Name: Creek Bend Blvd Extension Date: 1/23/17
City Project Change Order/Quantity
ID Number ST33CBDR Adjustment No. 5
3ustification
Quantity Adjustment/Change Order No. 5 for the amount of$220,239.08 is for the addition of the following items. Surface milling and placement
of 2"asphalt overlay on Creek Bend Blvd.from Sam Bass Rd.to FM 3406.The closure of voids 7, 8 and 9 as approved by TCEQ.An increase in
block sod installation for lawn restoration, addition of precast concrete corridor fencing,addition of Hydro Seeding,addition of anti-graffiti
coating for bridge structure, addition of an 8"rock rip rap layer for erosion control, and galvanized expansion plates for the sidewalk on the
SUMMARY Amount %Change
Original Contract Price: $8,089,168.50
Previous Quantity Adjustment(s): $77,770.27
This Quantity Adjustment: $91,159.00
Total Quantity Adjustment(s): $168,929.27
Total Contract Price with Quantity Adjustment(s): $8,258,097.77
Previous Change Order(s): $195,739.25 0.02
This Change Order: $137,461.78 0.02
Total Change Order(s)To Date: $333,201.03 0.04
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $8,591,298.80 -
Difference between Original and Adjusted Contract Prices: $502,130.30
Original Contract Time: 435
Time Adjustment by previous Quan.Adj./Change Order: 140
Time Adjustment by this Quan.Adj./Change Order: 6
New Contract Time: 581
Submitted for Approval
Prepared By: Randy Crum, Project Manager, City of Round Rock 1/27/17
Signature Printed Name,Title, Company Date
------------ - -----
_ Approvals
Contractor: ZO/✓
S'gnature Printed Name,T' le, Company Date
City Project
Manager: Randy Crum, Project Manager, City of Round Rock 1/27/17
Signature Printed Name,Title Date
Mayor/City
ManagerO/M
Signature Printed Name,Title Date
g..�vry - kAl�S
Page 2 of 3
Contract Quantity Adjustment/Change Order
ROl1N0 ROtlC TEAS
rev,06/15
Project Name: Creek Bend Blvd Extension
Quan. Adj./Change Order No.: 5
Change Order Data
Contract
Time
Adjustment
Item # Item Description Unit Qty. Unit Price Amount (Days)
1 Block Sod SY 450 $6.76 $3,043.40
2 4'Wrought Iron Gate EA 5 $975.66 $4,878.30
3 Hydro Seeding SY 7165.873 $1.89 $13,543.50
4 Void 7,8, and 9 Closure LS 1 $5,964.02 $5,964.02
5 Anti-Graffiti Coating for Bridge Structure SF 6930 $1.15 $7,969.50
6 2"Type C HMAC Sam Bass to 3406 Ton 1156.56 $81.00 $93,681.36 3
6 Galvanized Expansion Joint Cover Plate EA 6 $1,396.95 $8,381.70
$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: $137461.78 3
Page 3 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK rFXAS
rev,06/15
Project Name: Creek Bend Blvd Extension
Quan. Adj./Change Order No.: 5
Quantity Adjustment Data
Contract
Time
Adjustment
Bid Item # Item Description Unit Qty. Unit Price Amount
37 8" Rock Rip Rap CY 247 $200.00 $49,400.00
16 Plane And Text Asph Conc Pav 0-2" SY 10653 $3.00 $31,959.00 3
199 6' Precast Concrete Fencing LF 140 $70.00 $9,800.00
$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: $91,159.00 3
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
77
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-164358
CAPITAL EXCAVATION
BUDA,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/09/2017
being filed.
City of Round Rock 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.
ST33CBDR
CREEK BEND BLVD
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
TRACY LEE MCTEER
r NOTARY PUBLIC
nature of authori ed agent of co racting business entity
STATE OF TEXAS le,9
''fe of iJ'y MY COMM.EXP.10-31-2018
AF
Sworn to and subscribed before me,by the saidA-0—L,Lthis the "I day of
20 to to certify which,witness my hand and sea&f office.
LCM
CL/—
Sign a of office dministering oath Printed na of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
7-7
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-164358
CAPITAL EXCAVATION
BUDA,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/09/2017
being filed.
City of Round Rock Date Acknowledged:
03/02/2017
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.
ST33CBDR
CREEK BEND BLVD
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party. ❑
X
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 V1.0.277