Contract - Control Panels USA - 5/13/2021 Page 1 of 3
_J� Contract Quantity Adjustment/Change Order
kook ,e ,
rev,0 1/16
Department: Utilities and Environmental Services
Project
Name: Communications and Water Treatment Plant Control System Improvements Date: 4/9/21
City Project Change Order/Quantity
ID Number SCADA Adjustment No. 1
Vendor Control Panels USA Inc. 16310 Bratton Lane, Suite 100, Austin,TX 78728 512-863-3224
Company Name Address Phone No.
Justification
During the bidding of this project, additional monitoring sites were added to the City of Round Rock utility.These additional sites will need
cellular routers installed and integrated into the new system.Additionally, monitoring the entire system on a single screen will be difficult,there
for a video wall will be installed to help manage the system. Construction days were changed in Addenda No. 2 during the bidding process and
not reflected in the executed contract,those days have been added to this Change order as well.
SUMMARY Amount %Change
Original Contract Price: $2,495,359.00
Previous Quantity Adjustment(s):
This Quantity Adjustment:
Total Quantity Adjustment(s): $0.00
Total Contract Price with Quantity Adjustment(s): $2,495,359.00
Previous Change Order(s): 0%
This Change Order: $89,925.00 4%
Total Change Order(s)To Date: $89,925.00 4%
Adjusted Contract Price [Original Contract Price Plus
Quantity Adjustment(s) Plus Change Order(s)]: $2,585,284.00
Difference between Original and Adjusted Contract Prices: $89,925.00
Original Contract Time: 380
Time Adjustment by previous Quan.Adj./Change Order:
Time Adjustment by this Quan.Adj./Change Order: 70
New Contract Time: 450
Submitted for Approval
Prepared By:
Signature Printed Name,Title, Company Date
' J Approvals
Contractor: a r W. I D S/11C Cl--'6 1 ` O S A 9,21
Sig l5rinted Name,Title, Company Date
City Project M
Manager: uc, ✓r� VU' ICn AssuCwIk( q 121
Signatur Printed Name,Title Date
Mayor/City
Manager 's p A5 ?j L.®z
Signatur Printed Name,Title Dat
R2024 - I25
Page 2 of 3
Contract Quantity Adjustment/Change Order
rev,01/16
Project Name: Communications and Water Treatment Plant Control System Improvements
Quan.Adj./Change Order No.: 1
Change Order Data
Contract
Time
Adjustment
Item # Item Description Unit Qty. Unit Price Amount (Days)
Furnish &Install Cradlepoint cellular
1 routers to 4 remote sites each 4 $4,300.00 $17,200.00 20
2 Furnish &Install 3x2 Video Wall lot 1 $71,525.00 $71,525.00 49
Furnish &Install Modicon Serial
3 Communications Card each 1 $1,200.00 $1,200.00 1
$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: $89,925.00 70
Page 3 of 3
Contract Quantity Adjustment/Change Order
Project Name: Communications and Water Treatment Plant Control System Improvements
Quan.Adj./Change Order No.: I
Quantity Adjustment Data
Contract
Time
Adjustment
Bid Item # Item Description Unit Qty. Unit Price Amount
$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
$0.00
$0.00
TOTALS: $0.00 0
CERTIFICATE OF INTERESTED PARTIES FORM 1295
loft
Complete Nos. 1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos. 1,2,3,5,and 6 it 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. 2021-744454
Control Panels USA Inc
AUSTIN,TX United States Date Filed:
2 Name of governmental entity or state agency that is a parry to the contract for which the form Is 04/28/2021
being filed.
City of Round Rock,Texas Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identity the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
SCADA
Change Order No. 1-Add routers to remote sites and furnish/install video wall for monitoring the entire system
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable
Controlling Intermediary
Salyer,Martin Austin,TX United States X
Wetherholt,Brian Austin,TX United States X
Morgan, David Austin,TX United States X
5 Check only it there is NO Interested Party. ❑
6 UNSWORN DECLARATION t '
My name is R T r►.J _ESL S c. .S(4 E ,- and my date of birth is
My address is_I to 3(4 Al-r'n,J
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct. -tom
Executed in tq visCounty, Stale of J ESe S ,on the24TN day of let t,, 20 f__
(month) (year)
(Signature of authoriz of contracting business entity
clarant)
Version V1.1.ceffd98a
Forms provided by Texas Ethics Commission vAvw.ethics.state,tx.us
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. 2021-744454
Control Panels USA 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 04/28/2021
being filed.
City of Round Rock, Texas Date Acknowledged:
05/04/2021
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.
SCADA
Change Order No. 1-Add routers to remote sites and furnish/install video wall for monitoring the entire system
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Salyer, Martin Austin, TX United States X
Wetherholt, Brian Austin,TX United States X
Morgan, David Austin,TX United States X
5 Check only if there is NO Interested Party. EJ
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 V1.1.ceffd98a