Contract - Smith Contracting Co., Inc. - 12/6/2018 r 3
Pagel of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK TEXAS .y,�', (7I''4+�I N A L
rev,01/16
Department: TRANSPORTATION
Project
Name: ROUNDVILLE LANE Date: 11/15/18
City Project Change Order/Quantity
ID Number Adjustment No. 3
Vendor SMITH CONTRACTING CO. INC. 15308 GINGER ST AUSTIN TX 78728 512-990-7640
Company Name Address Phone No.
Justification
CO/QA#3 will remove the Bonded Concrete Overlay from the project and introduce the reguar mill and overlay costs.Additionally, CO/QA#3
add,and removes, items that were not required due to the discovery of a solid rock subgrade in several locations.
SUMMARY Amount %Change
Original Contract Price: $2,699,825.69
Previous Quantity Adjustment(s): $106,763.75
This Quantity Adjustment: -$103,629.75
Total Quantity Adjustment(s): $3,134.00'
Total Contract Price with Quantity Adjustment(s): $21702,959.69
Previous Change Order(s): $38,692.50 1%
This Change Order: $24,682.00 1%
Total Change Order(s)To Date: $63,374.50 2%
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s)Plus Change Order(s)]: $2,766,334.19
Difference between Original and Adjusted Contract Prices: $66,508.50
Original Contract Time: 270
Time Adjustment by previous Quan.Adj./Change Order: 36
Time Adjustment by this Quan.Adj./Change Order: 0
New Contract Time: 306
e- ,., ub.m.itted fox Approval ._
Prepared B :
N y Hardin m II VP Smith Contracting Co.Inc. 11-15-18
Signature
- -
Signature Printed Name,Title, Company Date
Approvals
Contractor:
Si ature Printed Name,Title,Company Date
City Project i
Manager:
Si at;
Printed Name,Title Date
Mayor/City0/
Manager • M+fl 2 •� •Cgj
Si na ure Print Name,T e I Date
Page 2 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK i EXAS
rev,01/16
Project Name: ROUNDVILLE LANE
Quan.Adj./Change Order No.: 3
Change Order Data
Contract
Time
Adjustment
Item# Item Description Unit Qty. Unit Price Amount (Days)
A TACK COAT FOR 2" PAVING GAL 885 $7.80 $6,903.00
B TRAFFIC CONTROLS LS 1 $9,039.00 $9,039.00
C TEMPORARY TABS LS 1 $1,840.00 $1,840.00
D ADDITIONAL MOBILIZATIONS EA 2 $3,450.00 $6,900.00
$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
r p,
Page 3 of 3
Contract Quantity Adjustment/Change Order
r F ROUND ROCK TEXAS
rev,01/16
Project Name: ROUNDVILLE LANE
Quan.Adj./Change Order No.: 3
Quantity Adjustment Data
Contract
Time
Adjustment
Bid Item # Item Description Unit Qty. Unit Price Amount (Davs)
94 TYPE B LIME SLURRY TON $1,900.00 -$3,800.00
95 LIME TREATED SUBGRADE -S7- 7, " -$1,944.00
96 FLEXIBLE BASE CY 164 $50.00 $8,200.00
97 PLAN &TEXT ASPH CONC PAV 0-3 IN SY 120 $3.75 $450.00
98 4 IN CONCRETE PAVEMENT BCO SY -7498 $34.00 -$254,932.00
99 PC CONCRETE CURB&GUTTER LF 5 $20.00 $100.00
79 HMAC TYPE C TON 825 $140.00 $115,500.00
7 LIME TREATED SUBGRADE (8 IN. SY -675 $4.25 -$2,868.75
8 10 IN. CONCRETE PAVEMENT SY 119 $66.00 $7,854.00
9 CL C CONC(MISC) CY 8.89 $800.00 $7,112.00
71 REMOVE P.C. CONCRETE SIDEWALK SF 292 $20.00 $5,840.00
74 TYPE B LIME SLURRY TON 14.4 $350.00 $5,040.00
75 LIME TREATED SUBGRADE (6 IN. SY 922 $9.50 $8,759.00
P.C. CONCRETE CURB AND GUTTER
80 (FINE GRADING) LF 53 $20.00 $1,060.00
$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
-$103,629.7510
CERTIFICATE OF INTERESTED PARTIES FORM 1295
10f1
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. 2018-426803
SMITH CONTRACTING CO INC
Round Rock,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 11/19/2018
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.
Roundville Lane Project
Roadway Reconstruction
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
I
5 Check only if there is NO Interested Party. !
X
6 UNSWORN DECLARATION
My name is b � ,
My address is � ;� {'� / i''T'�' W er'. �
, ./',�
(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 .today of� ,20 .
(month) (year)
I
I
Signature of authorized agent of contracting business entity
(Declarant)
i
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711
I
Y
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. 2018-426803
SMITH CONTRACTING CO INC
Round Rock,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 11/19/2018
being filed.
City of Round Rock Date Acknowledged:
11/21/2018
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 Project
Roadway Reconstruction
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 V1.0.6711