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Home My WebLink About2018-102SECTION 00942 - Change Order Form No. 1 DATE OF ISSUANCE: May 10, 2018 EFFECTIVE DATE: May 10, 2018 OWNER: Indian River County CONTRACTOR Blue Goose Construction. Project: Forest Park Water Main Ext. OWNER'S Bid No. WA 2017-008 You are directed to make the following changes in the Contract Documents: Description: Add/Deduct line items/quantities from contract. Reason for Change Order: Final Pay Application: Adjust contract amount to reflect actual constructed material and quantities, and delete contingency. Attachments: See itemized schedule CHANGE IN CONTRACT y�OhtiMISS/p.. PRICE: Time Description Amount Original Contract Price $74,920.78 Net Increase (Decrease) $0.00 from previous Change .oQi Orders No. (days) Contract Price prior to this $74,920.78 Change Order: Net increase (decrease) of ($14,532.38) this Change Order: (days or dates) Contract Price with all $60,388.40 approved Change Orders: ACCEPTED: By: CONTRACTOR (Signature) Date: �� f CHANGE IN CONTRACT TIMES y�OhtiMISS/p.. Description Time Original Contract Time: (days or dates) Substantial Completion: s* Final Completion: Net change from previous Change .oQi 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: ,a, J, / /7: ?? , ?16 [NEER (Signat e) Date: 4/�/ 20/ APPROVED: OWNER (Signature) Bob Solari, Vice Chairmar Date: June 5, 2018 APPROVED AS TO FORM y�OhtiMISS/p.. AND LEGAL SUFFICIENCY ,��'�' • �F�'� - BY s* DNrL. AN RE1NG0L0 COUNTY ATTORNEY .oQi C:\Users\tgormanlAppData\Local\Microsoft\Windows\INetCache\Content.Outlook\7DX40179\CO-1 WA2017-008.docx 00942-1 o= y ->.w 8•'�: •'•._ R/lir : �e1� .•' 0 P U b 0 U -H E APPLICATION FOR PAYMENT NO.2 - FINAL To: Indian River County Utilities From: Blue Goose Growers, LLC (CONTRACTOR) Contract: 1290 PO #: Project: Forest Park 6" WM Extension For Work completed through the date of 04/17/18 1 Original Contract Price: 2 Net change by Change Orders and Written Amendments (+ or 3 Current Contract Price (1 plus 2) Contractor Purchased Material 4 Total completed and stored to date: 5 Retainage (per Agreement) of completed work of stored material $ - Total Retainage: 6 Total complete and stored to date less retainage (4 minus 5) 7 Less previous Application for Payments 8 DUE THIS APPLICATION (6 MINUS 7) Accompanying Documentation: $ 74,920.78 (14,532.38)= 60,388.40 3,827.06 64,215.46 64,215.46 59,046.05 $ 5,169.41 CONTRACTOR'S Certification: The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of Work done under the Contract referred to above have been applied on account to discharge CONTRACTOR's legitimate obligations incurred in connection with Work covered by prior Applications for Payment numbered 1 through 1 inclusive; (2) 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); and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and not defective. Dated: 5 1 oil State of Florida County of St Lucie Blue Goose Growers, LLC CONTRACTOR By: -A�4,o,,�— Greg Hampto Control r Subscrib d and sworn to before me this 0 day of l 2018 Notary Public TERESAGORMAN aR1�Y'y'�� = MY COMMISSION t: FF 945828 My Commission expires: :+= ber 22, 2019 ��ms BondedftuNotaryPublio UnderwritersPayment of the above AMOUNT DUE THIS recommended. Dated: Min/11. L Indian River County Utilities Forest Park 6" Water Main Extension Pay Application 2 - 04/17/18 ITEM NO ' ITEM DESCRIPTION CONTRACT QUANTITIES UNIT UNIT PRICE TOTAL AMOUNT PREVIOUS PERIOD QUANTITY VALUE INSTALLED THIS PERIOD QUANTITY VALUE INSTALLED TOTAL TO DATE QUANTITY VALUE INSTALLED 216.1290 PERCENT % COMPLETE COMPLETE 01c Install 6" PVC Water Main 695.00 LF $6.00 $4,170.00 695.00 $4,170.00 $0.00 695.00 $4,170.00 100.00% 100.00% 07b Install 6" HDPE Horizontal Directional Drill (SDR -11) including fusion of MJ adaptors 530.00 LF $38.85 $20,590.50 530.00 $20,590.50 $0.00 530.00 $20,590.50 100.00% 100.00% 16a Install 6x6" Wet Tap with 6" Gale Valve 1.00 Ea $900.00 $900.00 1.00 $900.00 $0.00 1.00 $900.00 100.00% 100.00% 16a Install 44" Wet Tap with 4" Gate Valve 1.00 EaM$250.00 $900.00 1.00 $900.00 $0.00 1.00 $900.00 100.00% 100.00 9 Install MJ Fittin s 0.75 ton S3.075.00 0.75 $3,075.00 $0.00 0.75 $3,076.00 100.00% 100.00 23 Test Holes / Potholes 35.00 Fla $8 750.00 35.00 $8 750.00 $0.00 35.00 $8 750.00 100.00% 100.00% 28 Install Tem ora Jum er 1.00 EA $500.00 1.00 $500.00 $0.00 1.00 $500.00 100.00% 100.00% 29b Fill Pressure Test Chlorinate&FlushWM 1280.00 LF $1920.00 1280.00 $1920.00 $0.00 1280.00 $1920.00 100.00% 100.00% 30b Install & Remove Sam le Paint 3.00 EA $825.00 3.00 $825.00 $0.00 3.00 $825.00 100.00% 100.00% 30c Take &Test Bacterialo ical Sam le 6.00 EA $900.00 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% 65 Saw Cut Remove and Dis ose of As halt 50.00 Ton $1,500.00 0.00 $0.00 8.25 $247.50 8.25 $247.50 16.50% 16.50% 67a Install Asphalt Cement Pavement Replacement over full trench width including Base and Sub -Grade Compacted 50.00 Ton $45.001 $2,250.00 0.00 $0.00 1 8.25 $371.25 1 8.25 $371.25 16.50% 16.50% 82 Clear and Grub 1600.00 SY $5.00 $8,000.00 1600.00 $8,000.00 $0.00 1600.00 S8,000.00 100.00% 100.00% 84 Load and Haul Debris to Landfill 20.00 ton $25.00 $500.00 20.00 $500.00 $0.00 20.00 $500.00 100.00% 100.00% 86a Lawn Restoration (Topsoil & Sod) Includes Watering 150.00 SY $2.25 $337.50 150.00 $337.50 $0.00 150.00 $337.50 100.00% 100.00 86b Lawn Restoration (Seed and Mulch) Includes Watering 1600.00 SY $0.50 $800.00 1600.00 $800.00 $0.00 1600.00 $800.00 100.00% 100.00% 88a Well Point Dewatering Set Up, Tier Depth up to 25', Minimum 30'X 30' Work Area 1.00 LS $3,500.00 $3,500.00 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% 88b Well Point Dewatering, Additional Points Needed for Lar er Area or Linear Work 100.00 EA $25.00 $2,500.00 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% 91 Mobilization, Demobilization, MOT (based on 10% Labor Cost): 1.00 LS $6.191.80 $6.191.80 1.00 S6,191.80 $0.00 1.00 $6,191.80 100.00% 100.00% Contingency 1.00 LS $6,810.98 $6,810.98 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% Original Contract Price $74,920.78 $67,459.80 $618.75 $58,078.55 DELETED WORK 30C Take & Test Bacterialo ical Sample -6.00 EA $150.00 -$900.00 $0.00 0.00 $0.00 0.00% 0.00% 65 Saw Cut Remove and Dispose of Asphalt -41.75 Ton $30.00 -$1,252.50 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% 67a Install Asphalt Cement Pavement Replacement over full trench width including Base and Sub -Grade Compacted -41.75 Ton $45.00 -$1,878.75 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% 88a Well Point Dewatering Set Up, Tier Depth up to 25', Minimum 30'X 30' Work Area -1.00 LS S3 500.00 -S3 500.00 $0.00 0.00 $0.00 0.00% 0.00% 88b Well Point Dewatering, Additional Points Needed for Larger Area or Linear Work -100.00 FA $25.00 -$2,500.00 $0.00 0.00 $0.00 0.00% 0.00% Contingency -1.00 LS 1 $6,810.98 -$6810.98 0.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% ADDITIONAL WORK 86A Lawn Restoration (Topsoil & Sod) Includes Watering 872.00 SY $2.25 $1962.00 705.00 $1586.25 167.00 $375.75 872.00 $1962.00 100.00% 100.00% 79C Removal of Concrete 12.84 SY $10.00 $128.40 $0.00 12.84 $128.40 12.84 $128.40 100.00% 100.00% 80 Install Concrete sidewalk 115.50 SY $1.90 $219.45 50.00 115.50 $219.45 115.50 5219.45 100.00% 100.00% -$14,632.38 $1,586.25 $723.60 $2,309.85 Material - Concrete 1.00 LS $656.23 $656.23 $0.00 $0.00 0.00 $0.00 0.00% 0.00% Material Asphalt 1.00LS $623.83 $623.83 $0.00 $0.00 0.00 $0.00 0.00% 0.00% Material Sad 1.00 LS $2 568.00 $2,547.00 $0.00 $0.00 0.00 $0.00 0.00% 0.00% $3,827.06 $60,388.40 $69,046.06 $1,342.35 $60,388.40 Amount Completed to Date $ 60,388.40 Contractor purchased material $ 3,827.06 Total Completed & Stored Less Retainage $64,215.46 Less Previous Payment $ 59,046.05 Amount Due Contractor $ 5,169.41 K\1-Projects\7- Projects Amrded\INDIAN RIVER UTILITIES LABOR CONTRACT\Billing\1290 Forest Park\1290 IRCU Forest Park -Pay application 2 FINAL 2017.04.17 1 of 2 SOV NAIL FARMS, INC. Invoice 26963 PO BOX 360054 MELBOURNE, FL 32936 (321)254-6746 APPROVED thesodfather@aol.com By Bryan Crain at 7:45 am,, Nov 29, 2097 BILLTO _.._ _ ... Blue Goose Growers PLEASE PAY 1900 Old Dixie Highway DATE Fort Pierce, FL 34946 .11/15/2017 JOB DESCRIPTION N' .0f ACTIVITY OTY RATE AMOUNT Bahia Pallet 6960 9 100.00 900.00T Floratam Pallet 6961 8 150.00 1,200.00T Thank you for your business! SUBTOTAL 2,100.00 TAX (7%) 147.00 TOTAL 2,247.00 216202.6315 A2161290 H 6960.- $963.00 TOTAL DUE 216202.6315 A2161290 H 6961 - $2,247.�� $1,284.00 THANK Y . NAIL FARMS, INC. PO BOX 360054 MELBOURNE, FL 32936 (321)254-6746 thesodfather@aol.com BILL TO Blue Goose Growers 1900 Old Dixie Highway Fort Pierce, FL 34946 JOB DESCRIPTION Vero Invoice 26992 APPROVED By Bryan Crain at 4:16 pm, Nov 20, 20,17 DATE . 11/16/2017 ACTIVITY OTY RATE AMOUNT —__....... _.._ _.__... _.__.� _._...._.. _ ._._. �_. __.._......- Floratam Pallet 1250!6961 .._..-. -- ......_....__. y2-1' ._...._...__ _...._... _.._._.._ 1X.A� 1,8 Bahia Pallet 3 100.00 300.00T Thank you for your business! SUBTOTAL - ev TAX (7%) TOTAL 216202.6315 A2161250 H 6961- $1926.00 _ ........ __..�_..._ 216202.6315 A2161290 H 6960 - $321.00 TOTAL'DUE $ 2^7.x- Z�e� THANKYOU l� r HANGER CONSTRUCTION INDUSTRIES, INC. P.O. Box 15065 est PaImBeach, FL 33416 .61) 793-9400 Plant: FT Pierce 106128 Blue Goose Growers, LLC 1900 Old Dixie Highway Ft. Pierce FL 34946 INVOICE DATE- j NQM13ER I PAGh 03/02/18 1 1371022 1 11 IWAW AFAV e$ ! Iax CEMEX CEMEX Construction Materials Florida, LLC CEMEX One Bay Crete Kennedy Concrete -11+t�11�t1�1[[rlrlr11111Jill 11�1[�rr[r[�nut'1',Ili[u�l[[ INV2INS.A000379 BLUE GOOSE CONSTRUCTION PO BOX 14709 FORT PIERCE FL 34979-4709 N INVOICE Date: 031,0112018 Invoice No: 9437245034 Terms: Net 15th Payment Due On: 04115/2018 Territory Manager: -HAGENS, CURTIS Job No: 14554530 Legal Address: 400 WOODLAND DR. Customer Job No. 1290 Account N0: 3172586 Account Name: BLUE GOOSE CONSTRUCTION For All inquiries Call: 833-675-7375 Remit To: CEMEX I PO Box 7301971 Dallas, TX 75373-0197 PAGE 1 OF 7 PO Number: 1290 DELIVERY ADDRESS: 400 WOODLAND DR., VERO BEACH, FL, 32961 Ship Date Dellvary Ref # Product Code 1 Description Qty UOM Net Price By UOM Units Amount Freight FTX 03101@018 8078504689 36555793 1202749 ENVIRONMENTAL CHARGE 1,000 EA $20.00 1 PC 1.000 $20.00 $0.00 T 031016018 8078504689 35555793 1247818 FUEL SURCHARGE 1,000 EA $17.50 1 PC 1.000 $17.50 $0.00 T 03101!1018 8078504688 35555793 1557665 2500 REG 3.500 YD3 $99.50 1 YD3 3.500 $34825 $0.00 T 0310112018 8078504688 35555793 1571252 SERV,PAYLOAD,CHARGEOVER3-8,CUBICYA 1.000 PC $200.00 1 PC 1.000 $200.00 $0.00 T 03!016018 8078504688 35555793 1586055 SERV,CONCRETE HANDUNG FEE PER LOAD 1.000 EA $10.00 1 EA 1.000 $10.00 $0.00 T 03/016018 8078504688 35555793 1589831 MONOFIUUAENT2IBER 2.630 LB $6.67 1 LB 2.630 $17.54 $0.00 T PO Subtotal 340 Yards 0.00 Tons $613.29 Material $0.00 Freight 1 $0.00 Other $4294 TaX • $656.23 Total APPROVED 1290/6921 � By Bryan Crain at 9:08 arra, Mar 26, 2018 ,�01 .•Hartir>trararcrrrerarar>trararar>tr�ra,g ✓�� «216202.6315 A 2161290 H 6921 rtrar>arar�rarar�rerar a uNrarar>trrrei 3.50 Yards 000 Tons $0.00 Freight $0.00 Other $42-94 Tax 5058.231nvolce Total 1 rw nivotss tncoWratea hareinby wfinw aBinap,wwA*UL,ainwue CraMArp1k&%M BAM. sa-- Stw mm 7erma erbcamiu e.smrs owownerdSsOers Oreucoo'a=#= pCV&M mass sod»sncns"iaa)as tukfsatfa@,eaets invoke rAmermon awe, meas aeat, w*wahm Wss,nted hww tarpmeons sMpene were deivefed ssm3co:ed wW further ex M5* egM to PaY taacowaa, rad, this Aveemnt Uftmsf s1wBaw eaeY.e Paymnu.