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HomeMy WebLinkAbout2006-072 aoo 6 - 07� SECTION 00450 CHANGE ORDER FORM CHANGE ORDER NO . 01 DATE : October 27, 2005 CONTRACTOR: Tim Rose Construction OWNER: INDIAN RIVER COUNTY AGREEMENT DATE : September 13 , 2004 PROJECT NAME: Discharge Outlet and Rip Rap Spillway Mat - North County R/O Brine Proiect Phase II , UCP 2208 WIP No 473- 169000-04507 The following changes are hereby made : 1 ) Decrease the Contract Price from $ 183, 046 .96 to $ 115,085 .00 . Original CONTRACT PRICE $ 183 ,046 . 96 Net Decrease Resulting from the elimination of the spillway structure , the underlayment fabric and other miscellaneous appurtenances $ 76 ,311 . 96 Subtotal $ 106 . 735 .00 Net Increase Resulting from additional material and labor $ 8 .350 . 00 Subtotal $ 115, 085 .00 The CONTRACT PRICE including this CHANGE ORDER $ 115. 085 .00 ORIGINAL CONTRACT TIME : 45 days No . Days 45 Current CONTRACT TIME adjusted by previous CHANGE ORDER No . Days N/A Net Increase Resulting from this CHANGE ORDER No. Days 310 Current CONTRACT TIME Including this CHANGE ORDER No . Days 0 .00 CHANGES ORDERED : I . GENERAL This change order is necessary to reflect the actual work and resulting costs performed under this Contract. II . REQUIRED CHANGES Decrease certain item quantities to reflect actual field conditions III . JUSTIFICATION To reflect the actual cost of the project Change ober Form oouo . _ i _ FoA W fG,iesVUTI LITY - ENGINEERN6A4V'I'V - Nonh ROAN RO 6nne bine Discharge - UCPe^208`Change Order No l Phar 11 vecised103705 Joc Funds for the project have been approved by the BCC from the Utilities Department Capital Projects Fund Account No . 473- 169000- 04507 Attachment 1 IV. WAIVER This Change Order constitutes full and mutual accord and satisfaction for the adjustment in contract price or time as a result of increases or decreases in costs and/or time of performance caused directly and indirectly from the change . This Change Order represents an equitable adjustment to the contract and CONTRACTOR hereby waives all rights to file a claim on this Change Order after it is properly executed . V. APPROVAL AND CHANGE AUTHORIZATION Acknowledgements : The aforementioned change, and work affected thereby, is subject to all provisions of the original contract not specifically changed by this Change Order; and , It is expressly understood and agreed that the approval of the Change Order shall have no effect on the original contract other than matters expressly provided herein . Change Order Request By: By: Board of CountwCommissioners Department of. Utility Services,, , Michael C . Hotchkiss , P . E . Indian River bun ty . Flo I Change (s) Ordered By: u �" Michael C . Hotchkiss, P . E . Arthur R e erger, Chair Marchf7a2006r RECOMMENDED BY: ACCEPTED ,BYr " t tA,ti Michael C . Hotchkiss , P . E . °i ° <;)q > `5 DEPARTMENT OF UTILITY SERVICES Timothy Rosen :e, . Engineer: Michgel C . /H-otchki s 9 / �oYr By: //tYhAF�`- , lY �c ^, i -�L, -al0 By: �� � •O D6 Signature & Date ignature & Date Title: Capital Projects Manager Title : Owner APPROVED BY: VIED AS TO FORM pl�!XOE OFINDIAN RIVER COUNTY. FLORIDOwner Ogg E . FENTY AT NEY * * END OF SECTION Joseph A . Bair Countycxa rr*rri,.rator awso -- z - P:AUilincsVOTfIJTV - L6GINELRINGAAV7P - AonM1 ROiN HO Mine Linc DlzcM1nrge - UCPCi.OH`CM1ange Ordcr Rol Pkrse 11 revisu1103705doc PAYMENT APPLICATION Page 1 TO: Indam River County PROJECT IRC Discharge Outlet and Rip R - APPLICATION It 3 Distribution to: 2640 25th Street NAME AND Discharge Outlet & Rip Rap Spillway LOCATION: PERIOD THRU: 12/16/2005 � OWNER Vero Beach FL BID # 6069 PROJECT #s: [ ARCHITECT FROM: Timothy Rose Contracting, Inc ARCHITECT: DATE OF CONTRACT: 11 /17/2004 ❑ CONTRACTOR 1360 Old Dixie Hwy SW ❑ Vero Beach, FL 32962 ❑ FOR: India River County CONTRACTOR'S SUMMARY OF WORK Contractors signature below is his assurance to Owner, concerning the payment herein applied for, that: (1 ) the Work has been performed as required in the Contract Documents, (2) all sums Application is made for payment as shown below. previously paid to Contractor under the Contract have been used to pay Contractor's costs for labor, Continuation Page is attached. - - _ materials and other obligations under the Contract for Work previously paid for, and (3) Contractor is legally entitled to this payment. 1 . CONTRACT AMOUNT $106,735.00 CONTRACTOR: n10 ac " , Inc. 2. SUM OF ALL CHANGE ORDERS $8,350.00 By Date: 'ZAC 3. CURRENT CONTRACT AMOUNT (Line 1 +/- 2) $115,085.00 Timothy Rose/ 4. TOTAL COMPLETED AND STORED $115,085.00 State of: Florida (Column G on Continuation Page) County of: Indian River v Pus MORGAN SMRH 301919 5. RETAINAGE: Subscribed and sworn to before + c h W COMM153 � 2008 a. 0.00% of Completed Work $0.00 me this day of �r ��� r s P S.6,1T1 Bud9dNd'ry X03 (Columns D + E on Continuation Page) v� ^'rangy' b. 0.00% of Material Stored $0.00 Notary Public: Morgan Smith (Column F on Continuation Page) My Commission Expires: March 21 , 2008 //�� rr ;;� Total Retainage (Line 5a + 5b or �LIU L Column I on Continuation Page) $0.00 ARCHITECT'S CERTIFICATION 6. TOTAL COMPLETED AND STORED LESS RETAINAGE $115,085.00 Architect's signature below is his assurance to Owner, concerning the payment herein applied for, (Line 4 minus Line 5 Total) that: (1 ) Architect has inspected the Work represented by this Application, (2) such Work has been 7. LESS PREVIOUS PAYMENT APPLICATIONS $0.00 completed to the extent indicated in this Application, and the quaility of workmanship and materials conforms with the Contract Documents, (3) this Application for Payment accurately states the amount (Line 6 from prior Application) of Work completed and payment due therefor, and (4) Architect knows of no reason why payment 8. PAYMENT DUE $115,085.00 should not be made. 9. BALANCE TO COMPLETION CERTIFIED AMOUNT.................................... .......... ........................................... (Line 3 minus Line 6) $0.00 (If the certified amount is different from the payment due, you should attach an explanation. SUMMARY OF CHANGE ORDERS ADDITIONS DEDUCTIONS Initial all the figures that are changed to match the certified amount.) � Total changes approved in ARCHITECT: previous months $8,350.00 $0.00 BY Date: Total approved this month $0.00 $0.00 TOTALS $8,350.00 $0.00 Neither this Application nor payment applied for herein is assignable or negotiable. Payment shall be made only to Contractor, and is without prejudice to any rights of Owner or Contractor under NET CHANGES $8,350.00 the Contract Documents or otherwise. PAYMENT APPLICATION OSS , INC. DOCUMENT CONTINUATION PAGE Page 2 of 2 PROJECT: IRC Discharge Outlet and Rlp R APPLICATION #: 3 Discharge Outlet & Rip Rap Spillway DATE OF APPLICATION: 11/14/2005 Payment Application containing Contractor's signature is attached. PERIOD THRU: 12/16/2005 PROJECT #s: A B C D E F G H I COMPLETED WORK STORED TOTAL PERCENT BALANCE # AMOUNT ITEM WORK DESCRIPTION SCHEDULED AMOUNT AMOUNT MATERIALS COMPLETED AND COMPLETE TO RETAINAGE PREVIOUS THIS PERIOD (NOT IN D OR E) STORED (G / C) COMPLETION (IF VARIABLE) PERIODS (D + E + F) (C-G) 1 Mobilization $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 1000% $0.00 2 Furnish 7 Install 16" Pipe DIP & HD $12,650.00 $12,650.00 $0.00 $0.00 $12,650.00 100% $0.00 3 Furnish & install all Fittings $13,585.00 $13,585.00 $0.00 $0.00 $13,585.00 100% $0.00 4 Furnish & Install Fabriform Concret $6,500.00 $6,500.00 $0.00 $0.00 $6,500.00 100% $0.00 5 Clearing Grubbing Removal of Muc $25,000.00 $25,000.00 $0.00 $0.00 $25,000.00 100% $0.00 6 Grassing( Topsoil & Sod) $3,000.00 $0.00 $3,000.00 $0.00 $3,000.00 100% $0.00 7 Record Drawinfgs, AsBuilt Survey $6,000.00 $6,000.00 $0.00 $0.00 $6,000.00 100% $0.00 8 IRC Force Account $25,000.00 $0.00 $25,000.00 $0.00 $25,000.00 100% $0.00 9 Add 90 Tee 2 16" GV 20' 16" DIP 4 $8,350.00 $8,350.00 $0.00 $0.00 $8,350.00 100% $0.00 TOTALS $115,085.00 $87,085.00 $28,000.00 $0.00 $115,085.00 100% $0.00 CONTINUATION PAGE FOR PAYMENT APPLICATION OSS, INC. DOCUMENT SECTION 00622 - Contractor's Application for Payment. doc Application for Payment No . For Work Accomplished through the period through Jan 12 2006 To: Indian River County (OWNER) From : Timothy Rose Contracting , Inc. (CONTRACTOR) Contract: Project: Discharge Outlet and Rip Rap Spillway Mat-North County R/O Brine Project OWNER's Contract No . ENGINEER's Contract No . x. ENGINEER x. [Here is an alternate Table that has a little more detail to help Contractor fill it out properly -plus it makes it easier for State to review for 319( h) Grant purposes] 1 . Original ContractPrice : $ 106 . 735 . 00 2 . Net change by Change Orders and Written Amendments (+ or -) : $ 8 , 350. 00 3. Current Contract Price ( 1 plus 2 ): $ 1151085 . 00 4. Total Work to date : 4 . a Percentage of Work completed to date : 100% 4 . b Total Work completed to date : $ 115 , 085 . 00 4 . c Total equipment and material stored to date : $_L0_0__0 ) 4 . d Total Work completed and stored to date: (4 . b plus 4 . c) $ 0 . 00 5 . Retainage (per Agreement) : 5 .a 10% of completed Work (0 . 10 x 4 . b): $ 0_00 5 . b 20% of stored equipment and material (0 . 20 x 4. c): $-0 . 00 5 . c Total Retainage (5 . a plus 5 . b) : $ 0 . 00 6 . Total Work completed and stored to date less retainage (4 . d minus 5 . 4 $ 0 . 00 7. Previous Payments : $-0 . 00 8 . AMOUNT DUE THIS APPLICATION (6 MINUS 7) : $ 115 . 085. 00 (1 ) Attach detailed schedule and copies of all paid invoices . 1 . Original Contract Price : $ 106 , 735 . 00 2 . Net change by Change Orders and Written Amendments (+ or $8 , 350M 3. Current Contract Price ( 1 plus 2) : $ 115 , 085 . 00 4 . Total completed and stored to date : $ 115 , 085 . 00 5 . Retainage (per Agreement) : 100% of completed Work: $ 115 , 085 . 00 0% of stored material : 0 . 00 Total Retainage : 0 . 00 6 . Total completed and stored to date less retainage (4 minus 5) : $ 115 , 085 . 00 7 . Less previous Application for Payments : 0 . 00 8. DUE THIS APPLICATION (6 MINUS 7) : $ 115 , 085 . 00 Contractor's Application for Payment-00622 00622 - 1 P aJrlitles\UTILITY - EMPLOYEE FOLDERSWA t PfefferWorth RO\Conlractor's Application for Payment-00622.doc Rev_ 06/01 £ abed 888L699ZLL dZT : 60 900ZJST UEZ CONTRACTOR'S CERTIFICATION: 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 and payment received from the last request for payment has been used to make payments to all subcontractors, laborers , materialmen and suppliers except as listed below; (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 dear 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 ); (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and not defective and (4) 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 th a e no claims against the OWNER. Dated2 - i.l= C� �OAITRA T - R) State of �02(Cl�/ County of „r J � Subscribed and s n to before me thiS+'VA! 4 CAROL T. BESANCON day of a-�_�6�_ 07� O y;1 �' MV COMMISSION k DD 452154 Notary Public �A,Ppz '-7`^ gr),�Cyy''y7 Zrof jt& aPIRES: September 27, 2009 co My Commission expires: taN®iApY s6nmw DIMWIT[DIMWIT[ /woo. . NOTICE OF NON-PAYMENT if one or more Notice of Non-Payment" or Notice to Owner" is received by the OWNER, no further payments will be approved until non- payment(s) have been satisfied and a "Lien Waiver" for each "Notice " has been submitted to the OWNER. Upon request, CONTRACTOR shall furnish acceptable evidence that all such claims have been satisfied. The CONTRACTOR may, with consent of Surety and indemnification of the OWNER against any claims, receive payment for work for which there is an outstanding Notice of Non-Payment" or `Notice to Owner. " CERTIFICATION OF ARCHITECT OR CONSULTING ENGINEER (WHERE APPLICABLE) : I certify that 1 have checked and verify the above and foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of the work performed and/or material supplied by the Contractor. Dated (ARCHITECT / ENGINEER) SIGNATURE CERTIFICATION OF ENGINEER / INSPECTOR- I have checked the estimate against the Contractors Schedule of Amounts for Contract Payments and the notes and reports of my inspections of the project. It is my opinion that this statement of work performed and/or materials supplied is accurate, that the Contractor is Contractors Application for Payment-Oosm 00622 - 2 'Al It'll irv _ cs.a. nva«.., ..�oo.... ....... ...__. .. ._..__..-__.._.._.� ._u:�._ ._. .._. ___. ......_ . £'d 888L499ZLL ONIlOV2Jil 0 3SOLi MiOINIl d8L £0 g0 91, qa3 observing the requirements of the Contract, and that the Contractor should be paid the amount requested above . {� Dated (ARCHITECT % ENGINEER) SIGNATURE Accompanying Documentation : [The Remainder of Page Intentional Left Blankl 00622 - 3 Contractor's Application for Payment-00622 F\Utilities\UTILITY - EMPLOYEE FOLDERS\Ah P(eHer\DOCUMENTS\Contractor's Application for Paymen400E224oc Rev. OS/Df From : (CONTRACTOR) Contract: Project: Bid Schedule Percent Estimated Quantity Item Unit Price Of Values y Amount Complete Material Amount Completed No . Quantity Amount Completed oho) Stored and Stored 1 . Mobilization $ 15 ,000 .00 $ 15,000 .00 100% $ 15,000.00 100% $0 . 00 $ 15,000.00 Furnish & Install 16" Pipe DIP & 2 . HDPE $ 12 ,650 .00 $ 12 ,650 .00 100% $ 12,650 .00 100% $0. 00 $ 12 ,650.00 Furnish & Install 3 . all Fittings $ 13,585.00 $ 13,585.00 100% $ 13 ,585.00 100% $0 . 00 $ 13,585 .00 Furnish & Install 4 . Fabriform Mat $$6 ,500 .00 $$6 ,500.00 100% $$6,500.00 100% $0 . 00 $$6 , 500 .00 Clearing , Grubbing and 5 . Removal of Muck $255000.00 $255000.00 100% $25,000.00 100% $0 . 00 $25 , 000 .00 Grassing (Topsoil 6 . & Sod) $3 ,000.00 $3 , 000 .00 100% $3,000 .00 100% $0. 00 $3 ,000.00 Record Drawings 7 . As- Built Survey $6,000.00 $6,000 .00 100% $6 ,000 .00 100% $0 . 00 $6000 .00 IRC Force , 8. Account $25,000.00 $25,000.00 100% $25,000.00 100% $0 . 00 $25 , 000.00 Add Tee 2 9. 16"GV20' 16"DIP $8 , 350 .00 $8 ,350.00 100% $8,350.00 100% $0. 00 $8 ,350.00 [Note: Total Schedule of Values Amount should equal the current Contract Price.] TOTAL AMOUNT $ 115, 085. 00 * * END OF SECTION Contractor's Application for Payment-00622 00622 - 1 F:\utilities\UTILITY - EMPLOYEE FOLDERSWn P(eHer\OOCUMENTS\Contractor's Application for Payment Rev05/01 .