The URL can be used to link to this page

Contract - Patin Construction, LLC. - 4/14/2016f.p.n.11-11-11, Mv, a(VI 5 Department Pr ojed Name: City Project ID Number Justification "I"ra rtabon . .. .. .. .. .. .. .. .. .. .. .. . .. . ........... .. .. .. .. . . . ...... .. . . .. . ..... . .... . . ........... .3eton Pa Exten.R.jon MedlcM Center Parl .. . ........ . .... . ........... .. . . ... . ............. L ... . I ....... ........ . . ......... . ... . ............................................... . - - -- — ----------- - - Pagge I oF4 Date. � 3 16 Change Order/Quarifty Adjusti"neint No. .... ............ 2 ........ . .. ........... Fua—nTtt—yAdJusb,nent/0ange Order #2 Cbncn-Ae Median to Fa—ce Iranite., Unliversity Wvd, Extenslon, Light Pole Relocation and Stamped tai ned Concrete Intersection. SUMMARY WgnM Contract Pdce� Pre�Aous Quantfty Adjustment(s): 7111p5 Quanbty Adjustrnent., Tot.M QuantityAdiwftent(s): Total Contract Nice with Q.anbty Adjustmpnt(s); PreVbus Charge Order(s)a 'This Change Ord r - Change Order(s) To Date:: Adjusted Contract Price [Odg4)N Contract Pd oe Plus Quantity Adjustment(s) Mus Change Order(s)] : Difference between Cha gr and Adjusted Contract Prices, OngnnM Conbact erne; Time A41qsstrnent by prcMous Quan. Adj./Chamje Q,dej-, 'rime Adjustment by tf* QUan. Adj./Oiange Order: New Contract Th,iiv-.'� red By„ ConVacton / - - f r naturp CAy Project Manager: .......... . .......... 'gnahire Mayor/duty Manager Signature Amount % Change $127,800.00 0.05 $337,959.00 O $46,5,759.00 0.17 .............. . ............................................ $507,55830 22.0 0 297 . . ......... Printed Narne, "FMe, Company m. Pdinted Name, Tffle, Company Date V�— I .. . .....M.._...................._. --- ----- Pdnted Name, Title Date. ata.; Contract Quantity Adjustment/Change Order llevWIS Prqj(.Kt Naiine: Setnrw Parkway Extei)siorm Me&a� Qmter Park y Quar. Adj,/Charige Order No. Ouantitv Adiustment Data Page 3 of 4 Bid Item # Item Description Unit qty® Unit Price Amount Contract rime Adjustment f nnual . ..................... . 7 HOT MIX ASP11--i CONC PAVEMENT (TY B) . . . ........... . ................ TON 92 $75.00 ... . ... . ...... . ............. $6,900..00 8 HGF MIX ASPH CONC PAVEMENT (TY C) TON 457 $90.00 $41,130.00 9 P.C. CONCRETE CURB & GUTTER LF 112 $11.00 $1,232.00 10 R.C. CONCRErE RIBBON CURB LF ",62 $10m -$620.00 1.1 NEW P.C. CONCRETE SIDEWALKS (5 IN) SIF 480 $5.00 $2,400.00 _..a__........... . REFLEC70RIZED PAVEMENT MARKERS . ......................... 23 (IFY-11-B-B) LF 1 $15.00 $15.00 .......................... 26 CELL FBR MILCH SEED (TEMP) (WARI114) . q1N)CY ...... :SWY 1.3964 $0.30—. -$4,189.20 41 RIPRAP (STONE PROTECTlON) (12 49 $80m $3,920.00 62 CONC (PVC) (SCHD 40) (2") RAV LF -87 $67..00 -$5,307.00 63 GROUND BOX ["Y C (162911)_W /APP ONEA 10 $975.00 $9,750.00 REFL PAV MRK TY I (W) 4" (BRK) (090 67 MIL.) i IF 10 $1m $10'.00 REFL PAV MIRK TY 1 (W) 4" (SL.D) (090 68 Mn ) LF -104 $1.00 -$1,04,00 . . ... ........ _ . . ... . ........................... . .... . ..... REIFL PAV MIRK TY I (W) 8" (DOT) (090 . .......... 69 MIL) I F -48 $1.50 -$72.,00 REFL PAV MRK TY I (W) 8" (SII...D) (090 70 MIL) LIF $lm ....................................... . .... . ... . ...... . . ................. REF� PAV MIRK I'Y I (W) 12" (SLID) (090 . .. . . .... . ............................................................. . . .... . ..... ...... ... ...... 71 MIL) LF: 307 $1.50 -$460.50 TE_FLPA7_M'RK TY I (W) _24" (SLD) (090 72 Mll ) $4.00____. -$72.,00 . . .. . ....... . Ri'--"FL PAV MRK 1-( 1 (Y) 4" (BRIG) (090 El.O 76 MIL) II...F 6 $.1.00 $610.00 REFL. PAV MRIK TY I (Y) 4" (9 D) (090 77 Mil ) II...F 597 $lm $597.00 . .......... . . . . .......... . . ..... .... . ..... . . ...................................... . . REFIL PAV MRK TY I (Y) 12" (SILD) (090 . .......... . . ...... . ... . ..... . . . .... ........... . ........ . . . .... .. ...... ........ ....... . ...... . ....... . .......... 78 MIL) LF 638 $1..50 $957.00 79 REFL PAV MRKR I�Yl.' C EA 55 $5.00 $275.00 . .. ... 80 REEL PAV MRKR TYII-A-A EA -20 $5.00-$100.00. — -FEEL _PAV ffR--KR —TYII-C-R $5�00 .... . . $160.00 . ....................... —JULIM _FXT RAV—MRK MRKS (4") —I—F— $64.00 83 ELIM EXT PAV MIRK & MRKS (8") "— LF . ------- ------------ 780 . ..... — - — ` - - _$4�00 320.00 — I DOSE AGGREGATE FOR GROUND . ........ . . ......... .... 90 CCIVER S -684 . .... .......... .. . ........ . . ........ $220.001 ........... -$13,680.00 Pa,ie 4 ol'4 Contract Quantity Adjustment/ Change Order P-O!'RIKK rev, 06,15 TOTALS: $41,799.30 a Page 2 of 4 . .. ... Contract Quantity Adjustment/ Change Order Project NarneS'etun Parkway E.,.`.xten54oin Medis Center Padmay Q,wn. Adf./Cliange Order No. Contract Time Adjustment It # Item Description . . . . . . . . . . . . . . Unit Qty. Unit Price Amount Da s STAMPED CONCRETE MEDIAN (HARRINGBONE STAMP WITH CO2 -1 BUTTERFIELD U16 HARVEST WHEAT) SY 684 $108.00 $73,872.00 _QO2 -f —PREPARINGRO—W —SFA— —'-6-�'-2---- $2,500.00 $15,500.00 CO2 -3 EWA—CATION —CY — — ----- —3-53"-' $6.00 $2,118.00 0012-4 FLEXIBLEBASE —CY —406 $5100 $21,518.00 COT:�--- A TYPE B 'TN 809 $1,00.00 $80,900.00 CO2 -6 HMAC f7p—Ec —TN —407-1 $128.00 $52,096.00 CO2 -7 SALVAGING AND PLACINGTOPSOIL 4" SY 1650 $6.00 $9,900m CO2 -8 CELL FIBER MULCH SEED SY 1650 $1.00 $1,650.00 CO2 -9 VEGETATIVE WATERING MG 50 $200.,00 $10,000.00 S7ABILIZED CONSTRUCTION CO2 -10 EN-FEINCEEA 1 $2,000.00 $2,000,00 ------ 60-2-11 SILT —FENCE . ........ - —LF 6-70 —$5.00—$3.,350.00 C-02-12 TN -SM RD SM —SUP&AM TYPE IO—BWG- —EA —1 $650.00 $650.00 C(5'2--13 RELOCATE SIGN EA . 1 . .......................... $300.00 $300�00 REF PAVEMENT —i�—ARVTYP�71 . . . . . ............... CO2 -14 BRK LF 120 $1.20 $144.00 002-15 REF PAVEMENT MARK TYPE 114" SLD LF 880 $1.20 $1,056.00 COT16REF PAVEMENT MARK TY 11 C -IR ---�A ---"'-6 $10.00 $60.00 --'EO--2-17 - — ------ - ELEM EXT PAVEMENT MARK 4" —"- LF B— 78 $2.50 $2,195.00 CO2 18 TRAFFIC CONTROL LIS 1 $12,000.00 $12,000.00 --�b-2 1-9 CONCRETE —PIER —EA — — - ----- $1,250.,00 (:;-02-20 ANCHOR BOLTS LS 1 $600.00$600.00 cff CONDUIT 2" 80 $15.00 $1,200.00 652-22 T— --.LF LEaRiam LS ........ . 1 . ..... $3,500�00 $3,500.00 0012-23 CRANE L113 . ......... 1 . . ..... . $2,500�00 . . .. ..... $2,500..00 STAMPED - MPED CONCRETE INTERSECTION ANTIQUE CORK, COACHELIA SAND AND 002-2.4 AUTUM BEIGE TO MATCH EXISTING SY 1.07 $300.00$32,100.00 CONCRETE WASHOUT PIT AND ...................................................... 002-25 REMOBILIZELS . ........... . .............. .... . . . .......... 1 $7,500.00 $7,500.00 . ......... . ............ .... �OTALK........ ...... ................ ii �337959MOO —0 CERTIFICATE OF INTERESTED PARTIES FORM 1295 _oft 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. 2016-33983 Patin Construction LLC Taylor, 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 04/01/2016 being filed. City of Round Rock 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 goods or services to be provided under the contract 2016 Seton Parkway Extension Medical Center Parkway 4 Nature of interest (check applicable) Name of Interested Party City, State, Country (place of business) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty ofperjury, that th disclosure is true and correct. , VICTORIA L.FILLMAN o Texas�.-.. � :Notary Public, c, i �., : = My Commission Expires 11"W�,'.;' November 15, 2016 Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE a (/ Sworn to and subscribed before me, by the said _ f (�( 1 l„ t Yr this the day of-A 12' 20�, to certify which, witness my hand and seal of office. C c ignatur of officer administering oath Printed name of officer administering oath Title of officer administe 'Ig oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312 CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-33983 Date Filed: 04/01/2016 Date Acknowledged: 04/05/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Patin Construction LLC Taylor, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Round Rock 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 goods or services to be provided under the contract. 2016 Seton Parkway Extension Medical Center Parkway 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling 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 V1.0.312