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Home My WebLink About2018-064SECTION 00942 - Change Order Form No. 1 DATE OF ISSUANCE: March 20, 2018 EFFECTIVE DATE: March 20, 2018 OWNER: Indian River County CONTRACTOR Blue Goose Construction. Project: 424 22nd Street SE Sewer Lateral Replacement OWNER'S Bid No. WA 2018-002 You are directed to make the following changes in the Contract Documents: Description: Deduct watermain relocation from contract. Reason for Change Order: It was anticipated that a 4 -inch watermain may need to be relocated in order to replace the sewer lateral. The relocation of the watermain was not necessary. Attachments: See itemized schedule CHANGE IN CONTRACT PRICE: Time Description Amount Original Contract Price $15,000.56 Net Increase (Decrease) $0.00 from previous Change Orders No. : (days) Contract Price prior to this $15,000.56 Change Order: Net increase (decrease) of ($6,809.31) this Change Order: (days or dates) Contract Price with all $8,191.25 approved Change Orders: CONTRACTOR (Signature) Date: 3 /,;-,10,120/A CHANGE IN CONTRACT TIMES Description Time Original Contract Time: (days or dates) Substantial Completion: Final Completion: Net change from previous Change Orders No.: (days) Substantial Completion: Final Completion: Contract Time prior to this Change Order: (days or dates) Substantial Completion: Final Completion: Net increase (decrease) this Change Order: (days or dates) Substantial Completion: Final Completion: Contract Time with all approved Change Orders: (days or dates) Substantial Completion: Final Completion: RECOMMENDED: By: 44w EN NEER (Signa ure Date: 312G120/9 APPROVED .AS TCm*. AN LEGAL, SUFFICI FAUtilities\UTILITY- Engineering\Projects -Capital Projects\18-0213 424 22nd St SW\00942 -Change Order Form .docx 00942-1 a) 0 oU ro 0 U u-4 0 a) U E m D LAN REIT GOLD OOUNTY ATTORNEY 00942 - Change Order Form Contractor's Application for Payment 424 22nd Stree SE Sewer Lateral Replacement To: Indian River County Utilities From: Blue Goose Construction PO No. WA 2018-002 Project No.: BG 1325 1 Original Contract Price: 2 Net change by Change Orders and Written Amendments (+ or 3 Current Contract Price (1 plus 2): 4 Total completed and stored to date: 5 Retainage (per Agreement): 0% of completed Work: 0 % of retainage: 6 Total completed and stored to date less retainage (4 minus 5): 7 Less previous Application for Payments: 8 DUE THIS APPLICATION (6 MINUS 7): Application for Payment No. 1 - FINAL For Work Accomplished through the period of 03/16/18 15,000.56 (6,809.31 $ 8.191.25 191.25 Total Retainage: $ - $ 8,191.25 $ 8,191.25 UNDER PENALTY OF PERJURY, the undersigned CONTRACTOR certifies that (1) the labor and materials listed on this request for payment have been used in the construction of this Work; (2) payment received from the last pay request has been used to make payments to all subcontractors, laborers, materialmen and suppliers except as listed on Attachment A, below; (3) title of all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond acceptable to OWNER indemnifying OWNER against any such Lien, security interest or encumbrance); (4) all Work covered by this Application for Payment is in accordance with the Contract Documents and not defective; and (5) If this Periodic Estimate is for a Final Payment to project or improvement, I further certify that all persons doing work upon or furnishing materials or supplies for this project or improvement under this foregoing contract have been paid in full, and that all taxes imposed by Chapter 212 Florida Statutes, (Sales and Use Tax Act, as Amended) have been paid and discharged, and that I have no claims against the OWNER. Dated I ` L By' antfm (CONTRACTO — must b gned by an Officer of the Corporation) Greg Hampton - Controller Print Name and Title STATE OF FLORIDA COUNTY OF ST LUCIE 1 Before me, a Notary Public, duly commissioned, qualified, and acting, per1sppnally appeared, who being by me first duly sworn upon oath, says that he/she is the C6Y�--Wt LR -r- of the CONTRA OR mentione above and that he/she has been duly authorized to act on behalf of it, and that he/she executed the above Contractor's Application for Payment and Contractor's Certification statement on behalf of said CONTRACTOR;1statements containpd herein are true, correct, and complete. Subscribed and swom to before me this 0— day of Y ` 20 L 1 Y bh is personally known to me or has produced 4 as identification. NOTARY PUBLIC: Printed name: 7ERESAGORMAN #FF 945828 Commission No.:d g* EXPIRES: December 22, 2019 r 'Bon ru egry public Underwriters Commission Expiration: qh°O Page 1 Pay Application 1 Indian River County Utilities 424 22nd Stree SE Sewer Lateral Replacement t WORK COMPLETED Item No. Description Qt Unit Unit Price Scheduled Value Previous Application Amount Quantity Total This Period Quantity Total Total Com feted Quantity Total 40.00 220.00) 9 Install Mechanical Restrained Joint Ductile Iron Fitting -0.25 Ton $4,100.00 $ 1,025.00 0.25 1,025.00 Olb Install 4" PVC Water Main 40.00 LF $5.50 $ 220.00 40.00 220.00 40.00 220.00 9 Install Mechanical Restrained Joint Ductile Iron Fitting 0.25 Ton $4,100.00 $ 1,025.00 0.25 1,025.00 0.25 1,025.00 10a Install Mechanical Restrained Joints on Existing Main, 3" through 6.00 EA $60.00 $ 360.00 6.00 360.00 6.00 360.00 Ila Lower/Offset Pipe by Excavation After Restraining Joints, 3" 40.00 LF $6.00 $ 240.00 40.00 240.00 40.00 240.00 13a Grout Pipe Abandoned and Left in Place, 3" through 8" 100.00 LF $12.00 $ 1,200.00 100.00 1,200.00 100.00 1,200.00 23 Test Holes / Potholes 8.00 EA $250.00 $ 2,000.00 8.00 2,000.00 8.00 2,000.00 55c Install 6" Sewer Service Lateral -Single (> 7') SDR 26 100.00 LF $15.00 $ 1,500.00 100.00 1,500.00 100.00 1,500.00 58 Gravity Sewer Tap- Single Residential Service -4"-8"includes 1.00 EA $500.00 $ 500.00 1.00 500.00 1.00 500.00 65 Saw Cut, Remove and Dispose of Asphalt 10.00 Ton $30.00 $ 300.00 10.00 300.00 10.00 300.00 66a Install Asphalt Cement Overlay -Type SP -9.5 A.C. over Existing 10.00 Ton $60.00 $ 600.00 10.00 600.00 10.00 1 600.00 67b Remove, Dispose of and/or Replace Rock Base Course, Compacted 20.00 Ton $20.00 $ 400.00 20.00 400.00 20.00 400.00 67c Remove, Dispose of and/or Replace Stabilized Sub- Grade Course, 20.00 Ton $14.00 $ 280.00 20.00 280.00 20.00 280.00 86a Lawn Restoration (Topsoil & Sod) Includes Watering 50.00 SY $2.25 $ 112.50 50.00 112.50 50.00 112.50 85a Remove and Properly Dispose of Asbestos Concrete Pipe or 1.00 Ton $750.00 $ 750.00 1.00 750.00 1.00 750.00 88a Well Point Dewatering Set Up, Tier Depth up to 25', (Minimum 30' 1.00 LS $3,500.00 $ 3,500.00 - 1.00 3,500.00 1.00 3,500.00 91 Mobilization, Demobilization, MOT (based on SO% Labor Cost): 1.00 LS $1,298.75 $ 1,298.75 - 1.00 1,298.75 1.00 1 1,298.75 Contingency 11.00 1 LS 714.31 $ 714.31 1.00 714.31 1.00 1 714.31 $ 15,000.56 Work Deleted Olb Install 4" PVC Water Main -40.00 LF $5.50 $ 220.00 40.00 220.00 40.00 220.00) 9 Install Mechanical Restrained Joint Ductile Iron Fitting -0.25 Ton $4,100.00 $ 1,025.00 0.25 1,025.00 0.25 1,025.00 10a Install Mechanical Restrained Joints on Existing Main, 3" through -6.00 EA $60.00 $ 360.00 6.00 360.00 6.00 360.00 Ila Lower/Offset Pipe by Excavation After Restraining Joints, 3" -40.00 LF $6.00 $ 240.00 40.00 240.00 40.00 240.00 85a Remove and Properly Dispose of Asbestos Concrete Pipe or -1.00 Ton $750.00 $ 750.00 1.00 750.00 1.00 750.00 88a Well Point Dewatering Set Up, Tier Depth up to 25', (Minimum 30' -1.00 LS $3,500.00 $ 3,500.00 1.00 3,500.00 1.00 3,500.00 Contingency -1.00 1 LS 714.31 $ 714.31 1.00 714.31 1.00 714.31 424 22nd St Sewer Lateral $ 6,809.31 . Total $ 8,191.25 $ $ 8,191.25 $ 8,191.25 Confidential Amount Completed to Date $ 8,191 Retainage @ 0% Total Completed & Stored Less Retainage $ 8,191 Less Previous Payment Amount Due Contractor 8,191 ' ✓ YL 7-'-1A - 3-1A Page 1