Contract - Chasco Constructors - 8/12/2021ROUND ROCK I CXAS
rev, 01/16
Department:
Project
Name:
City Project
ID Number
Vendor
]ustification
Contract Quantity Adjustment/Change Order
ENGINEERING SERVICES
KENNEY FORT BLVD SEGMENT 4 B Date: 7/27/21
CHASCO CONSTRUCTORS
Page 1 of 3
Change Order/Quantity
Adjustment No. 1
PO BOX 1057 ROUND ROCK, TX 78680 512-244-0600
Company Name Address Phone No.
TIME AND MATERIALS ASSOCIATED WITH CONFLICTS AND PLAN REVISIONS. BROADCAST SEED (TEMP) QUANTITY ADJUSTMENT.
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:
Original Contract Time:
Time Adjustment by previous Quan. Adj./Change Order:
Time Adjustment by this Quan, Adj./Change Order:
New Contract Time:
Prepared By:
gnauire
0
Submitted for Approval
BLAKE CHAPPELL, PROJECT MANAGER, CHASCO
Printed Name, Title, Company
Approvals
Amount
$31548,558.05
$0.00
-$24,465.30
-$24,465.30
$3, 5241092. 75
$102,166.70
$102,166.70
$3,626,259.45
$77,701.40
Change
FIF wz (
Date
Contractor: BLAKE CHAPPELL, PROJECT MANAGER, CHASCO �� Z
Si nature Printed Name, Title, Company Date
City Project y {
Manager: 27 "21
Signature Printed Name, Title Date
Mayor/City
.Manager i.
'Sign ure Prin ed Name, iMe Date
R— 20-011 e2o I ,
0%
3%
3%
Page 2 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK I I., ?:.�5
rev, 01/16
Project Name: KENNEY FORT BLVD SEGMENT 4 B
Quan. Adj./Change Order No.:
Change Order Data
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
1106001
EXCAVATION (CP 1)
CY
3480
$5.00
$17,400.00
1326001
EMBANKMENT (CP 1)
CY
3480
$5.00
$17,400.00
1326002
EMBANKMENT (CP 1)
CY
3480
$5.75
$20,010.00
N/A
FRENCH DRAIN AT DRY UTILITY TRENCH
(CP 2)
EA
1
$6,510.00
$6,510.00
N/A
CONCRETE FLUME AT STA 200 (RFI 2)
EA
1
$2,250.00
$2,250.00
N/A
MANHOLE ACCESS AT (3) JCTBOX (RFI 9)
EA
1
$3,500.00
$3,500.00
1006002
PREPARING ROW (CP 4)
STA
6
$432.00
$2,592.00
1046021
REMOVING CONC CURB (CP 4)
LF
1906
$3.00
$5,718.00
1056008
REMOVE STAB BASE AND ASPH PAVING
(CP 4)
SY
2949
$3.30
$9,731.70
1106003
EXCAVATION (CP 4)
SY
780
$13.00
$10,140.00
1606003
FURNISHING AND PLACING TOPSOIL (CP
4)
SY
3600
$0.35
$1,260.00
1646003
BROADCAST SEED (CP 4)
SY
3600
$0.15
$540.00
5006001
ADDED BOND (CP 4)
LS
1
$300.00
$300.00
1326001
EMBANKMENT (CP 5)
LS
1
$1,595.00
$1,595.00
5316001
CONC SIDEWALK (411) (CP 5)
SY
35
$38.00
$1,330.00
1056008
REPLACE SPLASH PAD (CP 5)
SF
120
$13.00
$1,560.00
1106003
LAYOUT/CAD (CP 5)
LS
1
$275.00
$275.00
5006001
ADDED BOND (CP 5)
LS
1
$55.00
$55.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS:
$102,166.70
0
Page 3 of 3
Contract Quantity Adjustment/Change Order
ROUND ROCK I i .t
rev, 01/16
Project Name: KENNEY FORT BLVD SEGMENT 4 B
Quan. Adj./Change Order No.:
Quantity Adjustment Data
Bid Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
1646009
BROADCAST SEED (TEMP) (WARM)
SY
-30531
$0.15
-$4,579.65
1646011
BROADCAST SEED (TEMP) (COOL)
SY
-30531
$0.15
-$4,579.65
2476366
FLEX BASE (CP 2)
CY
-408.16
$37.50
-$15,306.00
$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:
- 24 465.30
0
cERTrF cArE of NrERESTEQ PARri�s
FORM
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CompleteNos. lw 4 and O"IKAhere areinterested parties. OFFICE USEONLY
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.
Cdmpete Nas. i, 21v 5; and 6-1t-th6re-are oo interested parties. CERTIFICATION OF FILING
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1 Name-cfbusIness:entItVIIIIng form, and the city, state and Gauntry of the business entity's place Certificate Num4er:
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of business:. 2021-783406
.
ChascoConstruCtOrs
---
Round Rock, TX United States Date Vtledi
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2"Name o governmentA[envyor state agency t at s a party to the contract far whUC t0.0rM"S-
----. ---------
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bethg fiCed.Rock
Date Acknowledged:
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3 Provide the Identification number Used.by the gouecnmentat entity ar state agency to track oridentifyt„e contract, and*ProVde a
.
destripto1 dfthe services, goods, ar pother property to 6e provided under the contract.
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QAC0-#1
Kenney FortSVvd. Segment QAlCQ4-�
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Name. of Interested Party City, State,: Country {place of business} (check APP11 bl'j
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Controlng Irtterm-e--9--.-.-
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KING, CHARLES Round Rock, TX Un"tedStates X
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ON. -n--
Glace Jr., Charles
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Round Rock, TX United States -
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5 Checkit there is NO IntorottedPattyE
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6 UNsORNDECLARATION ------- ------ ------
My name is and my date of birth is.�i •� ` � t
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My address is _��t� V a►
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(street) (city) (state) W code) countryl
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declare underpenalry of perjury that the foregoing is truetnd.COrreot.
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County, Mate of , dnAhe day of M I , 2
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(month) .(year)
V;g.nakure of a prized agent n} cantracbng business -entity
(De,darant)-- - ---- ------------ ---------------
Forms provided -by Texas EM.cis Commission wuvw.ethics.state.tx,us
er-
wA:V1A.d-.-e.ffd98a
•4
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CERTIFICATE OF INTERESTED PARTIES FORM 1295
10fl
Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos, 1, 21 31 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. 202lm783406
Chasco Constructors
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 07/27/2021
being filed.
City of Round Rock Date Acknowledged:
07/28/2021
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.
QA/CO #1
Kenney Fort Blvd. Segment 4B QA/CO #1
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
KING, CHARLES
Round Rock, TX United States
X
Glace Jr., Charles
Round Rock, TX United States
X
5
Check only if there is NO Interested Party. ❑
6
UNSWORN DECLARATION
My name is ,and my date of birth is
My address is , � - - -
(street) (city) (state) (zip code) (country)
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,ethicsstate,tx,us version via.cettaq8a