Contract - Smith Contracting Co., Inc. - 6/28/2018 Page 1 of 3
Contract Quantity Adjustment/Change Order
r-.-
encu Texas
rev,01/16 _
Department: TRANSPORTATIGN
Project
Name: ROUNDVILLE LANE Date: 4/26/18
City Project Change Order/Quantity
ID Number Adjustment No. 1
Vendor SMITH CONTRACTING CO.INC. 15308 GINGER ST AUSTIN TX 78728 512-990-7640
Company Name Address Phone No.
Justification
Change order items are items that were omitted from the bid proposal.Quantity adjustments were made based upon existing conditions at the
site,that resulted in a meeting with the geotechnical engineer,that advised to remove and replace a clay section and to take out the lime in
this section and instead install 6"of additional base material.It as also decided to remove junction box 6 and 45 linear feet of RCP,and just let
the UPS tie into our junction box.
SUMMARY Amount %Change
Original Contract Price: $2,699,825.69
Previous Quantity Adjustment(s):
I
This Quantity Adjustment: $35,439.25
Total Quantity Adjustment(s): $35,439.25 -
Total Contract Price with Quantity Adjustment(s): $2,735,264.94 j
Previous Change Order(s): 0%
This Change Order: $18,170.00 1%
Total Change Order(s)To Date: $18,170.00 1%
Adjusted Contract Price [Original Contract Price Plus Quantity
Adjustment(s)Plus Change Order(s)]: $2,753,434.94 j
Difference between Original and Adjusted Contract Prices: $53,609.25
Original Contract Time: 270
Time Adjustment by previous Quan.Adj./Change Order:
Time Adjustment by this Quan.Adj./Change Order: 0
New Contract Time: 270
Submitted for Approval
Prepared By: i! /'T7CPL41 o /40)1!;�7 !/ JG-/?
Signature Printed Name,Title,Company Date
Contractor: �A "Al CAM I V A44
Signature Printed Name,Title,Company 1.044i;4+A jn°tiJLiTMy Date
City Projectr /' —
Manager: 62 e-2 /Y.
Sig ure in ted Name Titl Da e
Mayor/City .L"&/ .
Manager
Si atureV Print Na e,Title-,04 Date
����00
Page 2 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK TEXAS
rev,01/16
Project Name: ROUNDVILLE LANE
Quan.Adj./Change Order No.: 1
Change Order Data
Contract
Time
Adjustment
Item# Item Description Unit Qty. Unit Price Amount Da s
1-1 ELEC SRV TY D 120/240 NS AESU EA 1 $6,440.00 $6,440.00
1-2 ILSN LED 9D EA 3 $3,220.00 $9,660.00
1-3 PED SIG SEC LED COUNTDOWNS EA 2 $1,035.00 $2,070.00
$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: $18,170.00 0
Page 3 of 3
Contract Quantity Adjustment/Change Order
IF-1-0!---r-
TEXA5
rev,01/16
Project Name: ROUNDVILLE LANE
Quan.Adj./Change Order No.: 1
Quantity Adjustment Data
Contract
Time
Adjustment
Bid Item# Item Description Unit Qty. Unit Price Amount (Days)
6 TYPE B LIME SLURRY TON -51.1 $165.00 -$8,431.50
7 LIME TREATED SUBGRADE (8 IN. SY -3437 $4.25 -$14,607.25
9 CL C CONC(MISC) CY 5.96 $800.00 $4,768.00
15 ICT BOX(COMPL)(PJB)(4X4) EA -1 $4,000.00 -$4,000.00
27 RC PIPE(CLIII)(18 IN) LF -45 $49.00 -$2,205.00
44 ALUMINUM SIGNS TY A SF 13.25 $24.00 $318.00
52 REFL PAV MRK TY I Y 24"SLD LF 22 $4.25 $93.50
53 REFL PAV MRK TY II W 8"SLD LF 236 $0.80 $188.80
64 PAV SURF PREP FOR MRK 8" LF 236 $0.32 $75.52
65 PAV SURF PREP FOR MRK 24" LF 22 $1.40 $30.80
72 STREET EXCAVATION CY 574 $20.00 $11,480.00
74 TYPE B LIME SLURRY TON $350.00 -$8,890.00
LIME TREATED SUBGRADE (6 IN.
75 THICK) SY -1712 $9.50 -$16,264.00
76 FLEXIBLE BASE CY 814 $45.00 $36,630.00
77 PRIME COAT MC-30 GAL 116 $18.00 $2,088.00
78 HMAC TY B TON 38 $90.00 $3,420.00
79 HMAC TY C TON 38 $140.00 $5,320.00
80 PC CONCRETE CURB&GUTTER FINE LF 152 $20.00 $3,040.00
83 REMOVE STR(INLET) EA 1 $400.00 $400.00
87 RCP CL 111 18" LF 281 $63.00 $17,703.00
97 PLANE&TEXT ASPH CONC PAV 0-3" SY 1141.7 $3.75 $4,281.38
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS: $35,439.251 0
CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
1 of 1
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. 2018-362046
MA Smith Contracting Co., Inc.
Austin,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 05/31/2018
being filed.
City of Round Rock,Texas 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 services,goods,or other property to be provided under the contract.
Roundville Lane Proj.QA/CO#1
Roundville Lane QA/CO 41
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
k
i
i
i
}
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is tit.tJ and my date of birth is
My address is ' �1 35 �C , ZU
1 t tt.fl�r } V
(st et) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in_ t.LL-� County, State of on thet day of ,20 .
(month) (year)
Sig_ature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
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. 2018-362046
MA Smith Contracting Co., Inc.
Austin,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 05/31/2018
being filed.
City of Round Rock,Texas Date Acknowledged:
06/19/2018
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.
Roundville Lane Proj. QA/CO#1
Roundville Lane QA/CO#1
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is and my date of birth is
My address is ,
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523