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Home My WebLink About2013-364 CONT Chg Order #1 - Blackline Inc - . Va CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER NO 1 PROJECT: ;2013 S]urrgSealProject#2012 10 = DATE IO/Q9~13 LOCATION: Ashland = PROJECT NO 2012 10 CONTRACTOR Blackline Ine w =1 You are requested to perform the following described work upon receipt of an approved copy of this document or as described by the Engineer: TtemNa RIM deg :iio~- - 1?anilt - IMMMM nee=-~ l~maun _ Item #1 Additional Slurry Seal 75s - d $ 2.18 $ _510- Item #2 Item #3 Item #4 $ Item #5 Total this Change Order ' $ 4 163 ~0 Previous Change Order Original Contract Total $ x4 827 21 7, Revised Contract Total $ 74,990.71 PERCENT CHANGE OF ORIGINAL CONTRACT 0.2% The time provided for completion of this contract is increased by no calendar days. This document shall become an amendment to the contract and all provisions of the contract will apply. Recommended By: to~ta t a Date Approved By: /0 d 9 -/:3 Blackline Inc. Project Manager2 Date Accepted By: 42 -,91 ` /3 Blackline Inc. ' Date be-c.VP M° Pr/ ~M o (2 l o - 16 - i 3 Nltt~ Fc~xcr+r zvt~ 'pu2a~i~. ytlotzrs Pt'r:s""~ e tno Td:551d88-SN] 1~, 20 E a, . ma NaiD Strcn Fu: 511A886006 AShlend, Or<SOn 9]530 TIY: 800-]35-2900 wW W.a96IMd.O f.uS 0apub- ~ . na\12-102012 Shtry SeeMnklim 1.612-10 Slurry S.1 Pmj.t AttauntinS Wodbook Page 1 / 1 ASHLAND CITY O F ITY KO RIDER DATE PO NUMBER 20 E MAIN ST. 8/9/2013 11797 ASHLAND, OR 97520 (541) 488-5300 . VENDOR: 008572 SHIP TO: Ashland Public Works BLACKLINE, INC (541) 488-5587 PMB 196 13023 NE HWY 99 STE 7 51 WINBURN WAY VANCOUVER, WA 98686 ASHLAND, OR 97520 FOB Point: Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Scott Fleury Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price THIS IS A REVISED PURCHASE ORDER 2013 SLURRY SEAL PROJECT 74,827.21 Public Improvement Contract Effective: July 1, 2013 Date approved by Council: 08/06/2013 Processed change order 10/24/2013 163.50 Change Order No. 1 Additional slurry seal - 75 sq yd SUBTOTAL 74 990.71 BILL TO: Account Payable - TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 74,990.71 ASHLAND, OR 97520 Account Number Project Number Amount " Account Number Project Number Amount E 260.08.12.00.70420 E 201210.999 7419-9-0.71 O signature ignature VENDORCOPY FORM #10 CITY OF CONTRA .T AMENDMENT APPROVAL REQUEST FORM ,ASH LAN D Request for a Change Order Name of Supplier 1 Contractor 1 Consultant: 3t e t ~uivE sNr_ Total amount of this puxe3 VkLo t10L3 WE "k-Y 19 contract amendment: Purchase Order Number: tl KI- Va c wvE~ ~fA • 1e rigrp Title/ Description: Zct'!:, 5N-%-)eey S~<*L $ tfi3 x❑ Per attached contract amendment Contract Amendment Original contract amount $ ~a r QZq ' rat 100 % of original contract Total amount of previous contract amendments % of original contract Amount of this contract amendment Ica -s ° •'i % of original contract TOTAL AMOUNT OF CONTRACT $ '7'`r`r1c, ' I tTn° Z % 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 NO' (If "NO", requires Council approval I Attach copy of CC.) Sourcing Method: SMALL PROCUREMENT • Less than $5000 INVITATION TO BID or COOPERATIVE PROCUREMENT QRF or ❑ 'YES', the total amount of contract and cumulative REQUEST FOR PROPOSAL EXEMPTION PURSUANT TO AMC 2.50 amendments 5$6,000. iZl 'YES", the total amount of cumulative amendments ❑'YES', the total amount of original contract and ❑ If'NO', amount exceeding authority requires s 25% of original contract amount or $250,000 cumulative amendments s $100K for Goods & Services, s Council approval. Attach copy of Council whichever is less. $75K for Personal Services, <$50K for Attorney Fees. Communication. ❑ If "N 0", amount exceeding authority requires ❑ If "NO", amount exceeding authority requires Council ❑ Exempt- Reason: _ Council approval. Attach copy of Council approval. Attach copy of Council Communication. PERSONAL SERVICES Communication. ❑ Exempt-Reason: ❑ "YES", Direct appointment5$35,000 ❑ Exempt-Reason:- El If "NO", requires approval. INTERMEDIATE PROCUREMENT SOLE SOURCE EMERGENCY PROCUREMENT Goods & Services • $5,000 to $100.000 ❑ "YES", the total amount of cumulative amendments ❑ Written Findings: Document the nature of the Personal Services-$5000 to $75,000 525% of original contract amount or $250,000 emergency, including necessity and circumstances ❑ "YES", the total amount of cumulative' whichever is less. requiring the contract amendment amendments 5 25% of original contract amount. ❑ If ❑ If "NO", amount exceeding authority requires ❑ Obtain direction and written approval from City 'NO', amount exceeding authority requires Council Council approval. Attach copy of Council Administrator approval. Attach copy of Council Communication. Communication. ❑ If applicable, attach copy of Council Communication ❑ Exempt-Re ason: ❑Exem t-Reason: ❑ Exempt -Reason: SPECIAL PROCUREMENT INTERGOVERNMENTAL AGREEMENT ❑'YES', the total amount of original contract and cumulative amendments are ❑ 'YES', the original contract was approved by City Council. within the amount and terms initially approved by Council as a Special Provide date approved by City Council: (Date) 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 ce of Coundl Communication. Project Number 70!_z -lo Account Numberlr~g 02.I-T-- -X0--- Account Number 'Expenditure must be charged to the appropri to account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed. Employee Signature: Department Head Signature: (Total amount of contract $5,000) City Administrator: ~ (Equal to or greaten an $2 ,000 or 10%) Funds appropriated for current fiscal year: (YES / NO Igx ~u~'f~J Finance Dlrecto r(Equal to or greater than $5,000) Date Comments: Form #10 -Contract Amendment Approval Request Form, Request fora Change Order, Page 1 of 1, 10/1512013