Contract - Cash Construction - 10/13/2016Page I of 3
_._ Contract Quantity Adjustment/ Change Order
MM"
rev, 08/12
Department: Transportation
Project
Name: CORR SWDT Ph 5A
City Project
ID Number SWDT5
Justification
Date:
Change Order/Quantity
Adjustment No.
7/12/16
4
,Quantity adjustments for additional concrete, waterline, electric, and paving work. Change order work for new concrete work, new gateway arch additions,
edge milling for mill and overlay work, and other mist. work
Approvals
Contractor:
SUMMARY
Amount
% Change
Original Contract Price:
$13,773,063.00
Printed Name, Title, Company
Previous QuantityAdjustment(s):
$820,268.40
{� n
This Quantity Adjustment:
$258,732.00
Manager:
Total Quantity Adjustment(s):
$1,079,000.40
Total Contract Price with Quantity Adjustment(s):
$14,852,063.40
Printed Name, Title
Previous Change Order(s):
$352,050.00
2%
This Change Order:
$419,383.30
3%
Total Change Order(s) To Date:
$771,433.30
5%
Adjusted Contract Price [Original Contract Price Plus Quantity Adjustment(s)
Plus Change Order(s)]:
$15,623,496.70
Difference between Original and Adjusted Contract Prices:
$1,850,433.70
Original Contract Time: 720
Calendar Days
Time Adjustment by previous Quan. Adj./Change Order: 35
Calendar Days
Time Adjustment by this Quan. Adj./Change Order: 0
Calendar Days
New Contract Time: 755
Calendar Days
Submitted for Approval
Prepared By: �'� B.J. Cash, Cash Construction
I I19
F.-2.OW ga�)15
SignaRre
Printed Name, Title, Company
Date
Approvals
Contractor:
B.J. Cash, Cash Construction 10
co f ��
nature
Printed Name, Title, Company
Date
City Project
{� n
Manager:
R S1.
Bill Stablein, Project Manager, CORR
�gnature
Printed Name, Title
Date
Mayor/City
Manager
/l/. /('i/y,
Y�
Alan McGraw, Mayor, CORR
Signature
Printed Name, Title
Date
F.-2.OW ga�)15
Pa. -e 2 of 3
Contract Quantity Adjustment/Change Order
rev, 08/12
Project Name: CORR SWDT Ph 5A
Quan. Adj./Change Order No.
Chanae Order Data
Item #
Item Description
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
Adjusus(Das
331
North Mays Guardrail include retrofil plate and 25 foot
temrinal anchor
LS
1
$4,290.00
$4,290.00
332:
:South M,=_,.Gus:, ,:- - "agdad
LS
1
3, 0 0 0.00
$3 0"
333
Gateway Arch Plan Changes for CMU Columns and Rock
Facade
LS
1
$20,640.00
$20,640.00
345
Edge Mill ( north bridge to 79)
LF
3916
$11.00
$43,076.00
351
Hot Mix Asphaltic Concrete Pavement, Type D (Method
B; 1.5 -inch)
SY
20833
$12.50
$260,412.50
352
Cleaning and Sealing Existing Joints
LF
1326
$44.00
$58,344.00
353 1
Header Type Expansion Joint
CF
40.8
$726.00
$29,620.80
$0.00
$0.00
Page 3 of 3
Contract Quantity Adjustment/Change Order
rev, 08112
Project Name: CORR SWDT Ph 5A
Quan. Adj./Change Order No.
Ouantitv Adiustment Data
Bid Item #
Item Description
p
Unit
Qty.
Unit Price
Amount
Contract
Time
Adjustment
(Days)
174
6" C-900 SDR 14 PVC Pipe
LF
180
$200.00
$36,000.00
_1.72,.,..
,.4" C 9PJ);}S.(1R,,14 PVC Pipe
LF 1
372
_ $19,0.0
185
6" MI Gate Valve w/Valve Box
EA
1
$1,400.00
$1,400.00
184
4" MI Gate Valve w/Valve Box
EA
3
$1,300.00
$3,900.00
176
6" MI Cap
EA
1
$300.00
$300.00
173
4" MI Cap
EA
2
$250.00
$500.00
84
6x6 Tapping Sleeve and Valve with 12x6 Reducer
EA
1
$5,500.00
$5,500.00
87
Removal of existing 8 -inch water line Contractor shall
maintain existing water services
LF
180
$120.00
$21,600.00
178
Ductile Iron Fittings
TON
0.15
$5,800.00
$870.00
77
nsta ing or Reconnecting Lateral Water Service to
Existing, or Replaced Pipe (Single 1-1/2" or 2" Water
Service Connection for City Meter, Backflow Preventor,
Etc.)
EA
11
$4,000.00
$44,000.00
81
Fire Hydrant Assembly per detail), includes leads and
6" Gate Valve
EA
1
$6,200.00
$6,200.00
245
Plane ASPH Conc Pav (TXDOT-354) (mill both Bridges)
SY
10428
$6.50
$67,782.00
$0.00
2.5 732.00
0
CERTIFICATE OF INTERESTED PARTIES FORM 1295
101`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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2016-106178
Cash Construction Company, Inc.
Pflugerville, TX United States
Date Filed:
08/30/2016
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
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.
S1NDT5
Quantity adjustments for additional concrete, waterline, electric and paving work. Change order work for new concrete work, new
gateway arch additions, edge milling for mill and overlay work
Nature of interest
4
Name of Interested Party City, State, Country (place of business) (check applicable)
Controlling Intermediary
Cash, Bruce
Pflugerville, TX United States
X
Gentry, Nathan
Pflugerville, TX United States
X
Cash, BJ (Bruce Jr.)
Pflugerville, TX United States
X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
STACY SMALL
YP
*a u°L� Notary Public, State of Texas
ter: < Comm. Expires 03 04-2020 ,k
vv,, Notary ID 11068934 Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
before by the • i �` the iy�'= day of ci
Swor to and subscribed me, said _�+c -,this
20 , to certify which, witness my hand and seal of office.
ignature of officer administering oath Printed name bf officer administering oath Title of officer administering oath
Forms provided by Texas Ethics commission www.etnres.5ta1e.rx.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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2016-106178
Cash Construction Company, Inc.
Pflugerville, TX United States
Date Filed:
08/30/2016
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
Date Acknowledged:
09/29/2016
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.
SWDT5
Quantity adjustments for additional concrete, waterline, electric and paving work. Change order work for new concrete work, new
gateway arch additions, edge milling for mill and overlay work
Nature of interest
4
Name of Interested Party
City, State, Country (place of business)
(check applicable)
Controlling
Intermediary
Cash, Bruce
Pflugerville, TX United States
X
Gentry, Nathan
Pflugerville, TX United States
X
Cash, BJ (Bruce Jr.)
Pflugerville, TX United States
X
5 Check only if there is NO Interested Party. El
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.etnics.state.tx.us vei aivii Vl.V.L!