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INDIAN RIVER COURi'i'Y, i+1,ORIDA
APPLICATION FOR PAYMENT NO_ .Final
PROJECT NO. 8 23 _ ACCOUNT NO:
PRDJECT: K no Hwy (SStti Ave) 25thjt to -26th St~
CONTRACTOR NAISEIADDRSSS:- 1]IU0=H F Q C.
P.O, Pravpr 719, Stuart, 9 lurid& 34995
APPLICATION DATE: g1 4jb4 -_-- -- _ FOR PERIOD ENDING 5235100 ---
Contractors Certification
The underoignod CONTRACTOR hereby certifies that all items and amounts on the
faces of thin applicaLian for payment are correct; that all work has been
performed and/or materials supplied in bull accordanen with the terms and
conditions of the contract.
The undersigned CONTRACTOR hereby swears under penalty of perjury that (1) all
previous progress payments received from the OWNER on account of work performed
under the contract referred to above have been applied by the undersigned to
discharge in full all obligatlons of the undersigned incurred in connection with
work covered by prior Applications for Payment under said contract, being
Applications for Payment numbered l through inclusive; and (2) all
materials and equipment incorporated in said project or otherwriae listed in or
covered by this Application for Payment are free and clear of all ling claisv�s.
security interests and encumbrances. Board of County Comrnissia
Dated 4� �� �9' aCJao ���.1�5-�. oYLORIDA Approved for Payment___ _L
BY:
June 20, 2000
COUNTY OF I[IQIAN RIVER
STATEMENT OF WORK
STATE OF FLORIDA
Original Contract Price
$5977266.93
Materials Stored
$!0,00 —
Net change Orders
$- 35'
(Attach detailod schedule and paid invoicss)
Current Contract Price
$6145232.- Z9
Total NorY./Materiale to Dates
$6145232.30
Work to Date:
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Lens % Retainage
ti r
Under Original Contract $ 527 93
sub Total
$6145232.3022-
Under change order
$ 167265,37
burn Prior Payments
$5594938.75
Percent of Work Completed to date 100 a
SAIMCS DUE THIS PAYMENT
$AS�Y,r�3 dt'(
Contractors Certification
The underoignod CONTRACTOR hereby certifies that all items and amounts on the
faces of thin applicaLian for payment are correct; that all work has been
performed and/or materials supplied in bull accordanen with the terms and
conditions of the contract.
The undersigned CONTRACTOR hereby swears under penalty of perjury that (1) all
previous progress payments received from the OWNER on account of work performed
under the contract referred to above have been applied by the undersigned to
discharge in full all obligatlons of the undersigned incurred in connection with
work covered by prior Applications for Payment under said contract, being
Applications for Payment numbered l through inclusive; and (2) all
materials and equipment incorporated in said project or otherwriae listed in or
covered by this Application for Payment are free and clear of all ling claisv�s.
security interests and encumbrances. Board of County Comrnissia
Dated 4� �� �9' aCJao ���.1�5-�. oYLORIDA Approved for Payment___ _L
BY:
June 20, 2000
COUNTY OF I[IQIAN RIVER
r (Name Title) _
STATE OF FLORIDA
Cari>lisae._p_ G.1�8
Defoe 1me tkvLa Ly'P,. day o1
,.Chairman
to d� ; personally appeared
to being duly sworn,
0bew-l" RZ
noun me, who
dapases and sayu that kAkhe
in t e O the CONTRACTOR above
mentioned; that (s)he executed
the above Application for Payvarnt and etatement
on behalf of said CONTRACTOR; and that all of ths statemento contained herein arR
true, icorruct and L'Lmpletwa.
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IA142
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INDIAN RIVER COUNTY, 'FLORIDA
CHANGE ORDER NO. 5
KINGS HIGHWAY CHASE I
Project No: 8823
Location: 58th Avenue/12th Street to 26th Street
Contractor: Dickerson Florida, Inc.
P.O, Drawer 719
Stuart, Florida 34995
Date of Issuance:
ITEM DESCRIPTION OF CHANGE QUANT. UNIT UNIT PRICE PRICE
NO, PRICE INCREASE DECREASE
A. Bridge
1
Review of Main Canal Deck Unit &
78.5
HRS
($90.00)
{$7,065.00
Sheet Pile Redesign
2
Barrier Wall Steel Relocation Review
6
HRS
($90:00
($540.00
3
Review of Wing Wall Revisions
4
HRS
($90,00
{$360.00
4
Review Penetrant Sealers
11
HRS
($90.00
($990.00
5
Review of Out of Tolerance Piles
6
HRS
($90.00
($540.00
6
Review of 3rd Submittals
12
HRS
(swooj
($1,080.00
7
Repair median separator
1
LS
$1,353J00
$1,35100
8
Install 4 scuppers Main Canal Bridge
1
LS
$3,300.00
$3,300.00
9
Eliminate camber between deck units
1
LS
$2,310.00
$2,310.00
on Main Canal Bridge sidewalk
10
Special Guardrail Posts
13
EA
$120.00
$1,560.00
11
Delete non-skid on Mn Canal Brdg Sdw
1
LS
($1,000.00
($1,000.00]
B. Roadway
1
Guardrail 'End Anchorage
a. Add ET -200
1
EA
$2,811.16
$2,811.16
b. Delete Type IV
-3
EA
$620.00
($1,860.00;
c. Add MELT
3
EA
$1,210.00
$3„630.00
2
Delete Gravity Retaining Wall(C.O. #3)
-209
LF
$126.45
($26,428.05;
3
Varible Message Sign
8
ED
$38.00
$304,00
4
Type S Asphalt
1032.19
TON
$37.50
$38,707-131
5
Pipe handrail, Main Canal'. Bridge
40
LF
$10.20
$408.00
7
Revise stabalized subgrade
27705
SY
$0.52
$14,406.60
quantity (C.O. #2)
8
Delete Rip Rap Rubble
-2332
Thi
$32.50
($75,790.00:
9
Removal and replacement of sidewalk
1
LS
$29,781.10
$29,781.10
and curb at County's direction
10
Temporary Pavement
-332
SY
$10.65
($3,535.80'
11
Concrete Barrier, Temporary
1343
LF
$12.50
$16,787.50
12
Barricade'remp. Type II
121744
ED
$0.33
$40,175.52
13
Barricade Temp. Type til
-37743
ED
$0.50
($18,871,51)
14
Subsoil Excavation
-2039
Cy
$2.30
($4.689.70
15
Geogrid
-2531.6
SY
$2.75
($6,961.79
16
Turnout construction asphatt
249.61
SY
$10.70
$2,670.83
Cage 1 of 6
40
4b
40
INDIAN RIVER COUNTY, FLORIDA
CHANGE ORDER NO. 5
KINGS HIGHWAY PHASE I
ITEM DESCRIPTION OF CHANGE
NO.PRICE
17 ,Type "S"" Asphalt 1-112""
QUANT.
UNIT
UNIT
$2.82j
PRICE PRICE I
INCREASE _DECREASE 6
_. ^i.
-438.67
SY
($1,237.05
18 Asphalt 518" FC -2
-492.1
SY
$1.50
I ($738.15a
19 Asphalt 1" FC -3
1361.92
SY
$2.15
$2.928.13
20 IMisc Asphalt Pavement
8.64
TN
$70.00
$604.80
21 (Curb & Gutter Type "F"
84
LF
$6.35
$533.40
22 Curb Type "D"
130
LF
$6.15
$799.501
23 Type I Traffic Seperator
-238
LF
$21.00
{$4,998.00
24 Concrete Sidewalk 4"
15
SY
$14.25
$213.75
25 Concrete Sidewalk 6"
98.3
SY
$19.95
$1.961.09,
26 MCo[ored Concrete
19
SY
$21.00
$399.00 j
27 ]Brick Pavers, Red
43
SY
$25.00
$1,075.001,
28 (Brick Pavers, Camel
35
SY
$25.00
$875.00
29 Guardrail, Roadway
-408
LF
$10.20
($4,161.60
30 Subsoil Excay. (C.O. 93)
-971
CY
$2.30
($2,233.30
31 Substation Concrete Drive
1
LS
$5,214.66
$5,214.66
C. Striping & Signals
1 61" solid white paint
500
LF
$0.22
$110.00
2 6" solid yellow pains
2578
LF
$0.22
$567.16
3 1,8" solid white paint
1150
LF
$0.44
$506.00
4 18" solid white paint
720
LF
$0.50
$360.00
5 18" solid yellow paint
228
LF
$1.65
$376.20
6 (merge paint message
2
EA
$66.00
$132.00
7 farrow paint
2
EA
$22,00
$44.00
8 reflective pavement markers
189
EA
$3.18
$601.02
9 reflective paint island nose
-33
SF
$6.94
($229.02'
10 (pavement messages
-8
EA
$86.00
($686.530,
11 directional arrows
-6
EA
$30.00
($180.0
12 guidelines thermo
-3
LF
$0.52
($1.56
13 6" skip white thermo
-3885
LF
$0.48
($1,864.80
14 6" skip yellow thermo
-1849
LF
$0.53
($979.97.
15 6" solid white thermo
-7529
LF
$0.36
y ($2,710.44
16 8" solid white thermo
490
LF
$0.59
$289.10!
17 12" solid white thermo
592
LF
$1.10
$651,20
18 18" solid white thermo
240
LF
$1.63
$391.20
19 24" solid white thermo
177
LF
$2.35
$415.95
20 6" solid yellow thermo
-8948
LF
$0.40
($3,579,20
21 18" solid yellow thermo
-103
LF
$1.77
($182.31
22 Gounding Electrode
-1.7
LF
$3.50
($5.95
23 Conduit Underground
94
LF
$2.96
$278.24
24 4" conduit
-20
LF
$8.00
($160.00
25 Pull ction
26 Pedestal
1
1
EA
$190.00
$190.00
27 Loop Assn Type "F"eS
14
EA
$320.00
$4.480.00
Page 2 of 6
INDIAN RIVER COUNTY, FLORIDA
CHANGE ORDER NO. 5
KINGS HIGHWAY PHASE I
ITEM
NO,
DESCRIPTION OF CHANGE 66ANT. I UNITS` UNIT
s ! PRICE
PRICE.
INCREASE
PR(CE
DECREASE
28
Loop Amp, Type "6"
101
EA !
$133-001
$1,330.001
29
Raise Controller Pad and 5 pull boxes
1
EA
$1,928.93
$1,928.93
D. Utilities
1
20" DIP WM (C.O. #3, B.7)
-38
LF
54.00
($152.00
2
Hydrant Relocation (C.O. #3, B.10)
-1
EA
$600.00
{$600.00}
4
6" DIP Fittings
-0-03
TN
$6,000.00
($180.00)
5
6" Steel Pipe Fittings
J -0.3
TN
$2,000.90 M
($600.001
6
61" DIP FM Underground
-112
LF
$20.00 i
($2,240.001
7
6" 'Steel Pipe
-45
LF
$50.00
($2,250.001
8
6" x 10" Tapping Sleeve
-1
EA
$3,000.00
($3,000.00)
9
8" DIP WM Fittings
-0.067
TN
$2,000.00
($134.00]
10
20" x 20" Tee
-1
EA
$5,600.00
($5,600.00
11
8" DIP WM Above Ground
9 P
LF
$90.00
$810.00
12
8" DIP WM Underground
15
LF
$30.00
$450.00
P
13
20" DIP WM Underground
28
LF
$158,00
$4,424.00
14
Water Valve Adj.
-4
EA
$150,00
($600.00)1
15
Relocate Water Meter
-1
EA
$900.00
($900.00
E. Drainage
{
1
P-5 < 10
-3
EA
$1,800.00
{$5,400.00
2
P'-5 >10
1
EA
$2,100.00
$2,100,00
3
P-6 t 10
1
EA
$1,700.00
$1.700.00
j
4
J-5< 10
1
EA
$2,800.00
$2,800.00
I
5
J-6 > 10
-1
EA
$3,200.00
($3.200.00
6
Type "'C"
-3
EA
$800.00
($2,400.00
7
P-7 X10
-1
EA
$1,500.00
($1,500.00
8
J-7 = 10
1
EA
$2,500.00
$2,500.00
9
J-7 > 10
-1
EA
$4,000.00
($4.000.00
10
S -77C, Replace 15" RCP with 10" DIP
1
LS
$220.00
$220.00
11
S-86 Modifications (C.O. 43, A.10)
1
LS
$490.00
$490.00
12
S-88 Modifications (C.O. #3, A,22)
1
LS
$660.00
$660.00
13
S-83, Hand Pour P-1 Inlet Top
1
EA
$2,365.00
$2,365.00
14
S-82 C, S-92, S-103 Material Cast
1
LS
$1,789.28
$1,789.28
for Eliminated Structures
15
S-99, Sawcut
1
EA
$302.60
$302,50
16
STA 291+05, Sawcut Weep Holes
1
LS
$792.00
$792.00
17
STA 299+90, C Inlet & 14' of 15" CMP
1
LS
$1,364.00
$1,364.00
18
Reduce depth of pond "G" and length
-2100
CY
$3.80
($7,980.00
of pond °H"
19
Add 120LF 46" CAP (C.O. #2) - 82LF
38
LF
$56.00
$2,128.00
20
Delete 10OLF 48" RCP (C.O. #2) + 2LF
-98
LF
$60.00
($5.880.00
21
Seed & Mulch College Pond
-581.77
SY
$0.20
($116.35
22
Sod ditch at College Pond Site
737.27
Sy
$1.10
$811:00
23
15" RCP Storm Sower
16
LF
$28.00
$448.00
Pepe 3 oll 6
c�]
4D
s
INDIAN RIVER COUNTY, FLORIDA
CHANGE ORDER NO. 5
KINGS HIGHWAY PHASE I
ITEM
NO.
DESCRIPTION OF CHANGE
24
18" RCP Storm Sewer
25
24" RCP Storm Sewer
26
36" RCP Storm Sewer
27
42" RCP Storm Sewer
28
54" RCP Storm Sewer
29
84" RCP Storm Sewer
30
18" RCP Cross Drain
31
24" RCP Cross Drain
32
15" RCP Side Drain
33
24" CAP Storm Sewer
34
18" CAP Crass Drain
35
24" CAP Crass Drain
36
15" RCP Side Drain
37
15"' RCP MES
38
30" RCP MES Basin Outlet
39
Relocate 5-39
F. Misc.
1
St. Augustine Sod
3
Double 16' Chainlink Gate
4
Barrier Gate
5
Deduct C.O. #4 - SIGN REMOVAL &
REINSTALLATION HURRICANE FLON
6
a. Repairs to Target Irrigation
$600.00
b. Replace vegetation at Target
7
Change fence at Pond "G" from
$1,214.40
galvanized to green vinyl
a
Relocate fence & gates at substation
9
Increase height block retaining wall
10
Green vinyl fence on College Lane
a. End post assembly
b. Gate post assembly
c. Pull post assembly
11
Inspectors overtime hours (see
attached summary)
12
25% credit on viburnum
13
Simpson Stopper crodit
14
Credit for Dahoon Holly Trees
15
Off Duty Law Enforcement
16
6" Type "B" Fence
17
Corner Post Type "t3" Fence
18
End Post Type "B" fence
19
Rail Fence
20
a. Relocate Fence
QUANT.
-144
195
-62
-27
-7
.8
-15
46
24
20
-5
15
0.5
-1
-1
1
442
W
UN$T
LF
LF
LF
LF
LF
LF
LF
LF
LF
LF
LF
LF
EA
EA
EA
LS
Sy
EA
EA
LS
LS
LS
LS
LS
LF
LF
EA
EA
EA
LS
PL
PL
LS
MH
LF
EA
EA
LF
LF
UNIT h
PRICE
PRICE
PRICE
INCREASE
DECREASE
{$4,752.00_
$32.00
$6,240.00
$42.00
{$2,604A0
$50.00
($1,354.00)
$75.00
($525.00
$170.00
($1,360.00)
$36.00!
{$540.00}
$36.00
$1,656.00
$22.00
$528.00
$31.00
$620.00
$40.00 ±
($200.00
$40.00
$600.00
$520.00
$260.00
$500.00
($500.00
$600.00
{$600.40)
$1,214.40
$1,214.40
$1.62
$700.40
$685.00
$5.879.40
$1,350.02
$485.69
$4,728.90
$2,964.50
$43.25
$10.18
$137.50
$1165.00
$192.50
$1.97
$10.04
$1,515.50
$26.25
$5.00
$110.00
$80.00
$10.00
$2.50
$7,163.E
$1,370.(
$1,350.0
$485.E
$4,728.5
$2,964.;
$4,180.1
$7,227.f
$275.(
$330.{
$192.;
$3,060,1
W0.1
$290.1
($2,1
Page 4 of 6
INDIAN RIVER COUNTY, FLORIDA
CHANGE ORDER NO. 5
KINGS HIGHWAY PHASE I
ITEM
DESCRIPTION OF CHANGE
QUANT.
UNIT
UNIT
PRICE
PRICE.
NO.
_I
I
PRICE `
INCREASE
DECREASE
b. Remove & Dispose of Fence
1
LS
$1,500.00
$1,500.00
21
Reset Existing Fence Gate
-2
EA
$75.00
($150.00
22
Barrier Gate
2
EA
$685.00
$1,370.00 i
23
Seed & Mulch
-1472.1
Sy
$0.20
($294.42
24
Sodding Bahia
-13888
SY
$1.10
($15.276.80
25
Goontie
-8
PL
$21.00
($168.00
26
Dwarf Grass
-126
PL
$6.56
($1326.56
27
Jasmine
-181
PL
$2.83
($476.03
28
Viburnum
-33
PL
$7.88
[$260.04
29
Dwarf Holly
-84
PL
$7.88
($661.92
30
Simpson Stopper
1
PL
$175.75
$175.75
31
10leander/Myrtle
-1
PL
$177.60
{$177.60
32
Live Oak
-1
PL
$647.50
($647.50
33
5" Wall
-50
LF
$48.35
($2,417:50
34
Maintenance & Watering at Westminist
1
LS
$1,980.00
$1,980.00
Presbyterian
35
Repairs to CVB Substation Fence
1
LS
$1,198.33
'$1,198.33
36
Remove exist. fence College Lane
167
LF
$1.10
$183.70
TOTAL iNCREASEIDECREASE IN CONTRACT PRICE
$264.888.27
($310,480.53
NET CHANGE IN CONTRACT AMOUNT
1 ($45,592.25
ORIGINAL CONTRACT PRICEITIME
CURRENT CONTRACT PRICEfTIME
AS ADJUSTED BY PREVIOUS
CHANGE ORDERS
NET CHANGE IN CONTRACT PRICEn IME
DUE TO THIS CHANGE ORDER
NEW CONTRACT PRICEITIME INCLUDING
THIS CHANGE ORDER
NEW CONTRACT COMPLETION DATE
$.5.977.966.93 546 DAYS
,%U9%824.53 54-Q DAY
{$45 592.25] 65 DAYS
$6.1_45.232.28 611_QAYS
November 30, 1999
Page 5 of 6
i
INDIAN RIVER COUNTY, FLORIDA
CHANGE ORIDER NO. 5
RINGS HIGHWAY PHASE I
FEITIM I ► kt_
I have examined the above changes. They are necessary to satisfactorily complete the Contract. The
price changes are reasonable and I recommend that the changes be made.
L. �`` 1 _� 1. ►... '`1i `�`-• X11+ -as J� �'" -t t' > ��' t- `
ENGINES DAT
I agree that the above changes in said Contract, in accordance with Specifications f('.r the price
changes sho40TRA
alis acts
,.a
TOF2 DATA
A,QQEEIED BY: INDIAN RIVER COUNTY, FLORIDA
rMPAYM Caroline D. ginn, Vice Chairman
---dune--20-r.-nof)
DATE
Page 6 of 6