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Home My WebLink About2013-003 CONT Chg Order #1 - Polaris Land Surveying CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER NO. #01 PROJECT: Alley Extension - N. Main Street to Lori Lane DATE: 12/21/12 LOCATION: Alley north of Colwell Chiropractic PROJECT NO.: 2012-30 CONTRACTOR: Polaris Land Surveying, LLC You are requested to perform the following described work upon receipt of an approved copy of this document or as described by the Engineer: Item No. Description Quantity Unit Amount Item #I Additional Su-ve ing Work 1 LS $ 1,199.00 Total this Change Order $ 1,199.00 Previous Change Order $ - Original Contract Total $ 3,500.00 Revised Contract Total $ 4,699.00 PERCENT CHANGE OF ORIGINAL CONTRACT 34.26% This document shall become an amendment to fe c rtract and all provisions of the contract will apply. Recommended By: ~2 Z211 2_ Proj an Dat Approved By: 2 Z Public Works Director Date Accepted By: Polaris Land Surveying, LLC P.O. Box 459 Ashland, OR 97520 Contractor Representative - Date PUBLC WORKS/ENGINEERING Tel: 541488-5347 A,, F.. Mein Srreet ras: S9 09829 Ashiand.Orteon 91510 TTY: 800.].115-2'KKI xww.sahWnd.m.us G:tput> wrksteng%12-30 ABey Extension - N Main to WA_Admin\12-30 Prot Acct Workeeek.x1sx P 0 L A i A s L ANDS UY►2YEYING, LLC a tr u a Bill TO., City of Ashland Public Works Date: December 12, 2012 10 Winburn Way Ashland, Oregon 97520 Re: Lombardi Property Line Adjustment 5urvey Attn: Scott Fleury 430 North Main Street & 431 Lori Lane Map No. 391E 05 DA, TL's 2700 & 2701 DE5CRIPTION QTY/HOUR5 RATE AMOUNT OFFICE: RE5EARCH / CORRE5PONDENCE 1.5 80.00 120.00 PPOFE55IONAL COMPUTATION5 Ob 100.00 50.00 DRAFTING / REPORT5 / LEGAL5 2.5 70.00 175.00 DOCUMENT PROCE551NG / RECORDING 3.0 60.00 180.00 REIM15UR5AIXEB: JACK50N COUNTY 5URVEYOR FILING FEE LUMP 5UM C05T 190.00 - JACK50N COUNTY CLERK-RECORDING FEE LUMP 5UM C05T 69.00 POLAP15 INVOICE #2 ROLLOVER FOR LUMP 5UM C05T _ 415.00 CHANGE ORDER #1 THANKYOUI TOTAL: $ 1,199.00 Payable upon Receipt 5tatement 003 REMITTANCE Project No. 662-11-PLO Previous Invoice $ 1,500.00 Payment:c' $ 1,085.00 This Invoice $ 1,199.00 Email: contact0polarissurvey.com Amount Due: $ 1,199.00 P. 0. Sox 459, Ashland, Oregon 97520 n Phone: (541) 402.5009 x Fax: (541) 400-0797 Mobile: (541) 601-3000 a wwv.polariss arv ey.ca. Page 1/1 4. IRECr"rs-! . CITY OF JL~ ASHLAND ' :-DATE 20 E MAIN ST. ` `PO NUMBER- 9/12/2012 11168 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 008064 SHIP TO: Ashland Public Works POLARIS LAND SURVEYING INC (541) 488-5587 PO BOX 459 51 WINBURN WAY ASHLAND, OR 97520 ASHLAND, OR 97520 FOB Point: Req. No.: Terms: Net Dept: Req. Del. Date: contact: Karl Johnson Special Inst: confirming? NO DescriOtion UnitPrice'` EztPrice THIS IS A REVISED PURCHASE ORDER Surveyinq services related to a 3,500.00 propertV line adjustment for 430 N. Main Street and 431 Lori Lane Contract for Personal Services Beginning date: August 27, 2012 Completion date: December 31, 2012 Insurance required/On file Processed change order 01/04/2013 1,199.00 Change Order No. 1 v5' SUBTOTAL 4.699.001 .BILL To: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 4,699.00 ASHLAND, OR 97520 - - _ s Account Number, „y ,';Project Number Amount i'.-,;A'ccount Number Project Number Amount`•, E 260.08.12.00.70420 E 200205.120 3,500.00 E 260.08.12.00.70420 E 201230.120 1,199.00 J /-3 Aut o iced Signature VENDOR COPY :i FORM #10 CITY OF CONTRACT AMENDMENT APPROVAL REQUEST FORM ASHLAND Request for a Change Order Name of Supplier I Contractor I Consultant: Polaris Land Surveying, LLC Total amount of this contract amendment: Purchase Order Number: #11168 Title I Description: Alley Extension - N. Main Street to Lori Lane $1,,199.00 ® Per attached contract amendment Contract Amendment Original contract amount $3,500.00 100 %of original contract Total amount of previous contract amendments % of original contract Amount of this contract amendment $1,199.00 34.3 % of original contract TOTAL AMOUNT OF CONTRACT $4,699.00 134.3 % of original contract In accordance with OAR 137-047-0800: 1) The amendment is within the scope of procurement as described in the solicitation documents, Sole Source notice or approval of Special Procurement. 2) The amendment is necessary to comply with a change in law that affects performance of the contract 3) The amendment results from renegotiation of the terms and conditions, including the contract price, of a contract and the amendment is advantageous to the City of Ashland, subject to all of the following conditions: a) goods and services to be provided under the amended contract are the same as the goods and services to be provided under the unamended contract; b) The City determines that, with all things considered, the amended contract is at least as favorable to the City as the unamended contract c) The amended contract does not have a total term greater than allowed in the solicitation document, contract or approval of a Special Procurement An amendment is not within the scope of the procurement if the City determines that if it had described the changes to be made by the amendment in the procurement documents, it would likely have increased competition or affected award of contract. Contract amendment is within the scope of procurement: YES X NO' (If "NO", requires Council approval I Attach copy of CC.) Sourcing Method: SMALL PROCUREMENT - Less than $5.000 INVITATION TO BID or COOPERATIVE PROCUREMENT, QRF or ® 'YES', the total amount of contract and REQUEST FOR PROPOSAL EXEMPTION PURSUANT TO AMC 2.50 cumulative amendments:5 $6,000. ❑ 'YES', the total amount of cumulative ❑ 'YES', the total amount of original contract and ❑ If 'NO", amount exceeding authority requires amendments 25% of original contract amount or cumulative amendments s $100K for Goods & Council approval. Attach copy of Council $250,000 whichever is less. Services, s $75K for Personal Services, < $50K for Communication. ❑ If 'NO", amount exceeding authority requires Attorney Fees. ❑ Exempt-Reason: Council approval. Attach copy of Council ❑ If 'NO", amount exceeding authority requires Communication. Council approval. Attach copy of Council ❑ Exempt - Reason: Communication. ❑ Exempt -Reason: INTERMEDIATE PROCUREMENT SOLESOURCE EMERGENCY PROCUREMENT Goods & Services - $5.000 to $100.000 ❑ "YES", the total amount of cumulative ❑ Written Findings: Document the nature of the Personal Services - $5.000 to $75.000 amendments 25% of original contract amount or emergency, including necessity and circumstances ❑ "YES", the total amount of cumulative $250,000 whichever is less. requiring the contract amendment amendments 25% of original contract amount. ❑ If 'NO', amount exceeding authority requires ❑ Obtain direction and written approval from City ❑ If 'NO', amount exceeding authority requires Council approval. Attach copy of Council Administrator Council approval. Attach copy of Council Communication. ❑ If applicable, attach copy of Council Communication. ❑ Exempt - Reason: Communication ❑ Exempt -Reason: 0 Exempt -Reason: SPECIAL PROCUREMENT INTERGOVERNMENTAL AGREEMENT ❑'YES'. the total amount of original contract and cumulative ❑'YES', the original contract was approved by City Council. amendments are within the amount and terms initially approved by Provide date approved by City Council: (Date) Council as a ,Special Procurement. If'NO", Council approval is required. Attach copy of Council Communication. ❑ If 'NO', amount exceeding authority requires Council approval. ❑ Contract amendment approved and signed by City Administrator. Attach co of Council Communication. Project Number 201230.120 (SEE COMMENT) Account Number 260.08.12.00.704200 'Expenditure must be charged to th p ate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed. Employee Signature: apartment Head Signature: ~rYl a 1St (w (Equal to or greater than $5,000) Funds appropriated for current fiscal year YES / NO Finance Director (Equal to orgreater than $5,000) Date Comments: PLEASE CHANGE PROJECT NUMBER FROM 200205.120 TO 201230.120 G:lpub-wrkslengl12-30 Alley Extension -N Main to Lon1AJldminlEng Vendor-2 (Polaris Land Surveying)1Contmct DocumentslChange Orders112-30 Form #10 - Request for a Change Order -#01.docx