Loading...
HomeMy WebLinkAbout2014-283 CONT Chg Order #1 - Roxy Ann Rock Cl) 'ct o00000000o pU'l o o O C) LO o vo d' M FCOONCD CDO00CD 0 IT O O O p co O COO M ZLO OI~OLOCD CD CD Co 0 C6 LO O O O I-- N mU.) UA D 00 69 In N) 00 69 69 6,> 6,).6,k N O 69 Ef> p O I` UA 00 OD 2 6q ~ ~ N 619- 64 O 64 6q a, 0 69 W L1J a' * ° o 69. z W w i°n f6 n Q Lu U O O LL U) a~i m OLOLr)~OLO Q N o cu NI-000ONfl O O W > C m~ OD U-) CD IT UO 'IT CO Q 6j U LLI a CL F ~W, c` a Q W 00 c ~ of o 0 fn J p Q ~ °o ° °o tcoa U) f- Q d ? O 00 O Z J co N J O N~ N~ N~ N F- N 1 F U w b rr b w b 1W O x O O Q m tU o N a) C ~ O U) m IL o C) o _0 Q Q o a) N a, co U w 0 E c: u) a 0 m 5 Z) O t~ N N -i w U) ma- CO m C c c C g O O J J ,O .o 0 0 0 0 0 (ll m a a n a 4, 0 O 0 a Y Y Y Y W cu m co cu m (D O p fY C Z J Z a) p 0000000000 p O O O O O p t ED d O N O O O O O O O O O O p 1- O O O O O p UO Y O m M cu 3: 11 F-- 000 ~ 000 60F} ~ 60R 6c~ C) C> V> ~ 64 p ¢ m 61) Off- O9- 0~ CV O Q~ Cl LL Un N , 69 It 66R z M Ln Y O O r F 69 Cf) M Cl) y O X Q LLJ o U U U) C) O o m o TO Ur) -a Q cu O O O 0 V z .o c Uri CD Uri o cfl 0 CY) a ltf F 00 CO LO Lm Z s W to H-) 69 Q D1-- . t: C: O N O Q z : o L) . Cl) Q U U) rn O ti N O O O c rn Y O O O O a) c6 _o a) V a) to y w L 00 00 00 Q V co 0 -1 U) U~ U m 0 a Z 2 r 0 CC W J ZD N o T- Of a~ co J =v~ F- O c~ O ¢ 0 LOO U~LL Q X LO U o c x O x o C: D a rn Q m a a I- z !C co o V O to s X c a a a a o Q O J= Lo rn O - a°i a6i ° ~6 i aci)i d a O Lo Q of rr rY (n (n rr Cn 0 > 2 m o m > C ~ C Y N N m O Y p u_ a o F E o UL z _ 0 m O w h UY C) C) ; c c Z LL O O ? N w ` 0 U) p >1 fy 10 Q Y U) 0 m cr C) L CL 0 o 30 11 Z H O L :3 C) F U) m i MEDFORD. OR ftA i"M 1M0 YlltlON WAY DMNerTa dm~isa.nathta#asyaeoa.arot W rl~O? Its. OR 97S914f090 From: Dhaoobdta Math Commwft: 10:0137 AUG 22 2014 FEI!3011 WATERAIORKS pdm QuabBon Pape s 1 _ Phone : 541-81&7411 Fax : 541-81&7419 BId 8188031 @/~( 1!14 CWt 5414M-7451 QuoW By: ORN Twm&....... : NET 10TH PRox Cuslonmr: WES NORTON Ship To. WES NORTON ASHLAND CREBC PARK ASHLAND CREEK PARK PO BOX 4488 PO BOX 4488 t~ED~ . OR 1 MEDFORD, OR 97M Cast .tab I Mmm. ASHLAND CREEK PARK Mnn OworlpYon Quandly Met Prim IN Told MuL0633o4 4 PVC SWR GXQXG WYE 1 15.880 EA 15.88 MUL063404 4 PVC SWR GXS 45 SEND 2 8.180 EA 18.38 MtA040949 4 PVC SWR HUB FEM 00 ADPT 1 4.940 EA 4.84 MULD40424 4 PVC SWR RH THRD 00 PLUG 1 3.010 EA 3.01 C05BOX G-6 V TRFC VLV WC ONLY 1 32.390 EA 32.39 Co6CS G-5C VLV Bx Cl LID SWR 1 22.510 EA 22.51 Nd Total: $94.89 Tax: $0.00 FjoWi Total: $94.89 Quobd pion am bmd upon noelpt d the told gw dlW for ImmodleM WpnMnt (48 hours). SHIPMENTS BEYOND 48 HOURS SHALL BE AT THE PRICE IN EFFECT AT TINE OF SHlMENT UNLESS NOTED OTHIERWISE. Sd pxonnotnnepm IN br deist's, tack d pmWuat or Ifw"n d b ue oerress 4 a~rtld ootrMrrpetrt Vw+ arYM'e taooep4erroe d SMlda trrn~esndaooi rdMiais, wMOh M aoid or putdoonerreros. TfMe Gout b Merrw eneen n W AA urdm I' no JIM. LEAD LAW!tAl with a we~.rtssole+riab ''s.wotlon»~d"c,t+"-01I10'°"T`~: a: cer, w"rbm in.w a '°~.a° 0AYA e \4y'rx vloc ~ OR WW VIM . 94100AWNWAY Dww►Tir. dem~ea. .0 so .g, 4waWvmwb MlOPM OR •789 410 From a~ surge" cxwm.nbc 1254A3 JUN062014 (Z /G Z ✓1 FEI IM8011 WATERWORKS Pda Owtr/on Pa0r9 1 PIwr:541418.7411 r'1 Fax 511818-7418 No-: 1" i - Im 6 r' aM„„: 06=4 ~ _ CM 541818.7411 TOMIL.......: NET 10TH PROX CONTRACTOR BODING ONLY Si* T06- CONTRACTOR 803M ONLY 0538 BWDINO PURPOSES ONLY 81538 BIDDING PURPOSES ONLY 985 MASON WAY 905MASON WAY LIEDFFORD. OR 97801 MEDPDRQ. OR 97501 QW POD ASHLAND CREEK PARK Jab NOW. ASHLAND CREEK PARK am osew"m qua MA Pdw UN Tell ASHLAND CREEK PARK BID RE5103 CONTROL .01 1 1 EA QPMFB80 30 PLAS f MM1Q~8 38X100 SLLT BCC 1 EA SLSW02BP12 9IN X 25 FT RTLE 1 EA MOMS 1X1X18 1 NOTE RIFY 1 NEEDED SUBT OTAL 75.30 HP350M 4X8 80A36 iNSERTA TEE 1 67 87'/: BPF~0 4M 90888 PVC QJ SWR PIPE 280 0.46f 27D?d~ MULDI3804 4 PVC SWR QXQXG WYE 2 EA 31.38 l• MULOU404 4 PVC SWR QXS 46 BEND 2 8.180 EA 1638 MULOUM 4 PVC SM QBKT CAP 5.870 EA 4m, C54400M 18GA 500 FT GAR UGF WIRE GM 500 54280 M 27.14 " SEWER CL.EANOUT8 cNnc` 1-0g,Sv88888 S$g ~ a S N ~L6 rppppcpppp ai ppQ 66 6pp N N O to iA !p to V! fI? fi? C%l fA Vl N r- to N 69 44). 49# 6* W o d► ago U W To h 0 3, To ~ OD N W c~ c x 7r- a L V~ W o o ~o p Q O = A~ deb _ J 6 a (a CM, o o c~p- J w H ~ d ~ I ~ A gl ti d m O d m O cc o a m Uo L O N N m 'o ~ d.: N m J m o- cj CJ 0 ~3m cr m o`~ v tm CM a :3 c O- y~ o d m Q Q I cc N =m -i w (a y w O O m o 0 0 0 a a Q 16 $ go co to m w ~ ~ Op COOppr e~ O O Z a; U 8 C*48 u~888 _ ad CIR S O IL 'm z I-- 641649p z to J9 ce Y O O O S ~rno~0 z° c cV a N to uW! ti 8 N O U CO) W r O F- 40. ER 69 F o L NON p 2 (D C Y N ~t j C S 1f1 N N t~ E C 2 8 W W C O O O N p O « $ W J V 3 2 z (n z m C J O c L O LO r U tL ILL Q +c U 'p m _ O t cD O U' 0) C = a a a a Q z O ~C o 01) t g > m O O c a E rx w 3 a co) cr 0 w U tea, sf J 8 d z O z a m 3 L- O ° o m V O 0aa w v~ J U am z ¢ w V m w o m i5 U v ti m O z Lorporase t rnces 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009-0160 Pape 1 of 1 H, D. FOWLER Phone 425-746-8400 • Fax 425-641-8885 COMPANY Medford Branch PO Box 160, Bellevue, WA 98009-0160 17 S Stage Rd , 44 9750, Medford OR (541) no-4a32 Fax (541) 7704599 s a,,pk'ng 13722434 To: WES NORTON dba BOXY ANN ROCK Ship to. HD Fowler Company - Medford P O BOX 4488 17 S Stage Rd MEDFORD OR 97501 Medford OR 97601 (541) 601-7451 Order# Inv Date: Order Writer: 04624699 08/20/14 Dale Haskell Tenma: NET 10TH PROX Ship Via: POW-B: 4" DIAM ND CUTTER FOB: H. D. FOWLER WILL CALL c~ -'z C Qty Qty Pan # Unit Extended T Une ShWd e0-d UOM Description Price Price X 1 1 E4 ITS412HS 151.63 151.63 4-11rSILVER WET DIAMOND BIT HOLE SAW FOR CONCRETE OR CLAY Sub total 151.63 Freight Tax Grand Total 151.63 WES Serving the Pacific Northwest since 1911 - % www.hdfowler.com mwVwD, OR WINl1586 M HAM M WAY DMwr Td: Wo~ertvr ks , OR WMt40 0 Pftw. m.d.~. ~.~r... 1234A3 A NL OO 2014 L LZ ,c rc Z FELMOH WATERWORKB P*Oombobn Plrp o 1 Pl o -.541.81&7411 a. F' F#x 5041W419 AW~~~: Bi68md Wd : 051AM C&W 5414hW411 ~K-- TMm&.....,.: NET ION PROX CLgpk AK: CONTRACTOR SDCMq ON.Y X* ft CONTRACTOR SCOM ONLY 91559 610Dpq PURPOSES ONLY #1586 DIDOINO P18iPOSES OPtY M6 MASON WAY 566 MASON WAY MEDFOM OR OW MEDFIDRD, CR OM CjWPKl#_ A*l AND tWEEK PARK Job !WANG ASH AND MEEK PMWK - -_L ..._.._d QmbdlV pit PAsr tM 7iN1t ASHLAPDCIWEK PARK - " "BID1 M3A S3 w CONTROL GPMF I0 30 PL;25Fr FL"t ji 1 EA M1►60'8 367(tPO6TEJL 8<SMl~12 9 M X RL YYATTLE EA UWSLi18 1X1X2 11orfVOW C4U,ED SUBTOTAL 7 630 S~ARY~IeIiRttiflilLW . _ _.••ar HP35W66 40 8oR,6 L MEMATEE 1 sTmo ~{7~°,•/` 80R86PP1A 4X80 80M PVC GJ SYMR PIPE 290 D.M7 FT 9TQ76~ MUe SIM 4 PVC SWR G MXG WYE 2 16.56O EA 31 AN Lr VuLo 11164 4 PVC SWR Gx846 0M 2 11.18 EA _ ISM"," Mutolm 4 PVCS MRGWCAP IS- am EA 46Wl [ l 0544090605 IWA SOO FT IRR UQF WIRE GRN 500 54.284 M 27:4 / SEWER CLEAMOUTS wrpora lm Unmes 13440 SE 30th St, Bellevue, WA 98005 PO Box 160, Bellevue, WA one 425-746-8400 Fax 49 25641-8885 Rage 1 of 1 H. Q FOWLER Ph COMPANY Monk Branch PO Box 160, Bellevue, WA 98W9-0160 17 s StW Rd . 97501 rs2 Fax (541) na•rseo Pm"" 13722178 (s41) 7704 M aR Fa To: VMS NORTON dba ROXY ANN ROCK Ship to: HD Fowler CMlpwW - Akdford P O BOX 4488 17 8 8"s Rd (541) 601-7451 Order bw Dow 04624343 Joshua Morrison _ Tema: NET 10TH PROX ship Via: .109: ACP CHANGE ORDER FOS: H. D. FOWLER WILL CALL ' Qhr Ch/ Part S Unk Exuded T Une She'd 9O'd UoU Price Price X 1 1 EA ROC134.215 111.40 111.40 C ROMAC SEWER SADDLE, C&4.215 O.D. RANGE 627 -14.40; 48" STRAP 2 2 EA SFKIIGG 8.34 16.68 4" PSM 45 DEGREE ELL,G X G,SDR 35 PVC FOR SEWER OR DRAIN 3 2 EA SFIIIGG 8.31 16.62 e PSM 221/2 DEGREE ELL,G X G.SDR 35 PVC FOR SEWER OR DRAIN 4 1 EA SFK11GU 7.49 7.49 e PSM 45 DEGREE ELI G X SP,SDR 35 PVC FOR SEWER OR DRAIN 6 1 EA SFHIIGG 22.60 22.60 4" PSM 11 114 DEGREE ELL,G X G,SDR 35 PVC FOR SEWER OR DRAIN 7 1 EA SFCRIIGG 10.29 10.29 4" PSM REPAIR CPLG GASKE:T,SDR 35 PVC FOR SEWER OR DRAIN Sub total 185.08 Freight Tart 0) 8cm8 C%j 8Lcq, 888$~N88 ~ Q60 o CL a 40 d* W a o -mc LL N co y 3 0 W _ W !o 'a ~0 j 9 Q m~ n Q X c w = CO) $ a .8 0 5; CO t, J 2 d cocr; N N N J C N r r r z L F- L~ cr6Iocr0-ir ° amUG E" _ m O O c yg C cN g N N co 3 tC m sr 4. O 2 J co 0 .2 -1 C V5 D Q = co I cl: W Q Q y _ > w' N C U Q U (y co n a a n C W Z ~ ~ ~ ~ g p) O d 5 G1 Z 0. 4 8888888888$ 8 8 8 r co m 10 U) CD V- r- U) O p _ p e- H3 tf! p 69 r N IZI- fQ W p 4& z (A EA 69 ~i r 8~888~ 8 8A. ~TzZ ~~c m - 4&~ - az c .It o Go)64 4& Z CO V N S m p O G ~ 0 IN N W C C 8 O; 8 8 8 C Lb c -j _ca Le) 8 k= a cr, H 0 L5 C D Q LL r' N a- r U LL lL r w U C N O r m c V W, O0 Q A J ~ m ce) J J C,1 fr. V- ca OD CL TL -1 0 p n a r r E o LLI 7! U. W W in c m z O z a m ~ Y m E U z w F d ° m m O a. Q w ti~ U U U JS wz S SO = N u CHANGE ORDER REQUEST Roxy Ann Rock CCB 203142 Date: 8/25/2014 Project Ashland Creek Park From: Shari Shattuck COR Number: 004 To: Steve Ennis Re: Sewer Line additional work This Change Order Request (COR) contains a quotation for a change in the contract sum or the contract time in response to proposed modifications to the contract documents based on contractor recommendation. Description of Change: Additional time required to locate sewer line not in plan location horizontally or vertically. Add sewer cleanout in valve box at SS Sta. 1+41 per City of Ashland Building Inspector Rick Hacksock Attach supporting information from: ❑ Subcontractor ®Supplier ❑ Reason for Change Differing site conditions and plans not showing required cleanout Does proposed change involve a change in contract time? ® Yes ❑No (increase) (decrease) amt. 1 day Does proposed change involve a change in contract sum? ® Yes ❑ No (increase) (decrease) amt. 1846.00 Contractors Name Roxy Ann Rock Date: 8/26/14 Contractors Signature Date: O O 0000000000000 Nt O O O 1c) 1,7 M I- 00 M M z I` OOOOOOOOO I.. In O O O Q ~O M ` D C V 0 0 0 0 0 0 0 0 0 j O O O O C; I- ti 0 M M 0 o H> 6c* 6c)- Ef} dc} 609, KT bc? EA O N Ef3 EH EA 64 m 14 m c") 0 H4 f!? Q ffl W 69. M at LU EA o O O r U LU U) O W V O M N? -O m N Q co (A O W O 4 (0 C 0 0 C) M CY) Q x ~ ~ cu c d O X N W o 0 0 `O o o 0 0 0 } Q a>i O -0 L) U N ti I- 0D J Z 0_ cvj J O N cu J 0 O O Q W~ c~ a) w~ a~ U DI I 0 0' O o d D 0 Of O ; Q OD U D H O co O o c U O as .0 cc L a' O U 5 Q 6 N O y O on E N O .3- a) 0Cl) ] a O p m ca w a- Co 2 (n g m ~ 0 0 o 0 U co n n o_ Q. 'a ~ C O > > O ^ O O O Y Y Y ` d L c- p U Z O o 0 0 0 0 0 0 0 o 0 o O (D N o o 0 00 s z n o7C3 o 0 0 0 0 0 0 0 0 o p N O o 0 o N m -;6 0 0000000000 c Q 6 ti o 0 o nj o ` O Q 16 D- Z 69 Et?mK?Ef}MEHff?fAM 00 K? In M 64 7C3 6pt 64 C0 O O z i 0_ U) W L d Q 4) Q u~ H N m 0 O >c LO V U U F N o U z~ LO 'a o cn in ri Lo a) X N (A O O co 6p* N p LL N Q (f3 ffl O LL Z Ld 15 0 U o M N C a 0 O < U U) a C) Q c Cl) N O m O U LO a) E U 0 a) L? co w .0 0- J Z Oo L C 0C60 m J O O C/) w m F- Of Q C U H O c p ~ N N i LL 0 LO c Q x U m -p c c = w U X OO c U W c Q (D na ao 0 O _0 'a Q O O~ a) m m m W m m 'C6 m Q- O Q- Q o in o rn i5 o i5 cn > o m m c Y m N (D ~ m m z O O O a m ° 0 0 W z o O ca N O N c a) Z O 1)f C) Z d -o 0 H (t O O w N m U Z W H O 9) > > < O o o W O a) w F- Y N N o m a) Z V 0 N C Q W E m L) zz n ~ U N o CHANGE ORDER REQUEST Roxy Ann Rock CCB 203142 Date: 8/25/2014 Project Ashland Creek Park From: Shari Shattuck COR Number: 003 To: Steve Ennis Re: Posts at Kiosk This Change Order Request (COR) contains a quotation for a change in the contract sum or the contract time in response to proposed modifications to the contract documents based on contractor recommendation. Description of Change: Treat (2) posts at kiosk, to be embedded in concrete, with Copper Green wood preservative. Attach supporting information from: ❑ Sub contractor ❑ Supplier ❑ Reason for Change Architect recommendation Does proposed change involve a change in contract time? ❑ Yes ®No (increase) (decrease) amt. Does proposed change involve a change in contract sum? ® Yes ❑ No (increase) (decrease) amt. 334.00 Contractors Name Roxy Ann Rock Date: 8/26/14 Contractors Signature cA Date: w i CHANGE ORDER REQUEST Roxy Ann Rock CCB 203142 Date: 4 August 2014 Project Ashland Creek Park From: Shari Shattuck COR Number: 001 To: Steve Ennis Re: Value Engineering This Change Order Request (COR) contains a quotation for a change in the contract sum or the contract time in response to proposed modifications to the contract documents based on contractor recommendation. Description of Change: • Bid Item #3: Use "Mud Mats" in lieu of rock construction entrance. Deduct $84.00 • Bid Item #5: Dismantle bam by machine instead of by hand. (This precludes sorting and inventory of "unpainted wood" as it will not be suitable for re-use.) Deduct $3,500.00 • Bid Item #18: Use of (1) 12' wide and (4) 5' wide pre-fab Hi-Qual gates (per attached info) instead of custom gates. Deduct $2,776.00 • Bid Item 420: Use pfe-fab bathroom windows (per attached info) instead of custom fabricated windows. Deduct $1,680 • Bid Item #20: Substitute electrical panelboard with standard 200 amp load center in lieu of bolt to buss as specified. Deduct $1,075.00 ex en eyon edges 444e-~~ Attach supporting information from: Q Subcontractor 0 Supplier 0 Reason for Change Owner requested Value Engineering proposal. Does proposed change involve a change in contract time? 0 Yes ® No (increase) (decrease) amt. Does proposed change involve a change in contract sum? © Yes 0 No increase (decrease) amt. 419,654.00 539,00 Contractors Name Roxy Ann Rock Date: 8/4/2014 Contractors Signature Date: 8/4/2014 ~1 ,7t;~4 Page 1 / 1 ASHLAND PARK COMMISSI~I 20 E MAIN ST. DATE PO NUMBER ASHLAND, OR 97520 8/21/2014 00385 (541) 488-5300 VENDOR: 004105 SHIP TO: ROXY ANN ROCK PO BOX 4488 MEDFORD, OR 97501 FOB Point: Req. No.: Terms: net Dept.: Req. Del. Date: Contact: Bruce Dickens Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price THIS IS A REVISED PURCHASE ORDER Construction of Ashland Creek Park 477,509.00 27 Hersev Street, Ashland Public Improvement Contract Approved by Council 07/15/2014 Completion date: 152 calendar days followinq Contractor's receipt of Notice to Proceed Processed chanqe order 10/27/2014 26,236.00 Chanqe Order No. 1 c7,- 3 SUBTOTAL 503 745.00 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 503,745.00 Account Number Project Number Amount Account Number Project Number Amount E 411.12.00.00.70420 E 000054.999 503 745.00 J Authorize ignaturej~ VENDOR COPY FORM #10 CITY OF CONTRACT AMENDMENT APPROVAL REQUEST FORM S H LAN Request for a Change Order Name of Supplier/ Contractor/ Consultant: try )UtU J~OC%~- Total amount of this Purchase Order Number: contract amendment: Ci'c'i 3 fS`_~ t?~ Title 1 Description: $ ❑ Per attached contract amendment Contract Amendment "177 ~o~ Original contract amount $ 100 % of original contract Total amount of previous contract amendments - % of original contract Amount of this contract amendment V `ill ~~C(~• s a % of original contract r ~r TOTAL AMOUNT OF CONTRACT $ ~U~ 7`1 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 1 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 cumulative R QUEST FOR PROPOSAL EXEMPTION PURSUANT TO AMC 2.50 amendments s $6,000. "YES", the total amount of cumulative amendments ❑ "YES", the total amount of original contract and ❑ If "NO", amount exceeding authority requires 25% of original contra6t amount or $250,000 ` cumulative amendments $100K for Goods & Services, Council approval. Attach copy of Council whichever is less. $75K for Personal Services, < $50K for Attorney Fees. Communication. ❑ If "NO", 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 appointment $35,000 ❑ Exempt- Reason: ❑ 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 - $5,000 to $75,000 25% 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 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 ❑ Exem t-Reason: ❑ Exem t-Reason: ❑ Exem t-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 co of Council Communication. - 'UDC •Z~JZQQ Account Number _ _ _ - _ _ - _ _ • - Project Number - Account NumberYJ_ -I. *Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed. Employee Signature :~C Department Head Signature: (Totalamountofcontract2:$5,000) City Administrator: - (Equal' o or greater than $ 5,000 r 10 Funds appropriated for current fiscal year E' / NO /.0 L / Finance Director (Equal too rester than $5,000) Da e Comments: Form #10 - Contract Amendment Approval Request Form, Request for a Change Order, Page 1 of 1, 10/20/2014 CITY OF ASHLAND PARKS DEPARTMENT CONTRACT CHANGE ORDER NO. 1 PROJECT: Ashland Creek Park DATE: 10/14/14 LOCATION: 27 East Hersey Street, Ashland, OR 97520 PROJECT NO.: 54.999 CONTRACTOR: Roxy Ann Rock, Inc. 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. _ Descri tion Quantity Unit Price 11 Amount Item #1 COR 001: Post Bases $ 539.00 Item #2 COR 003: Posts at Kiosk $ 334.00 Item #3 COR 004: Sewer Line Additional $ 1,846.00 Item #4 COR 006R: 4"-0" on Plaza $ 15,323.00 Item #5 COR 008R2: Fill Hole from Asbestos $ 8,194.00 Item #6 Hersey Street Sidewalk $ - Total this Change Order $ 26,236.00 Previous Change Order $ - Original Contract Total $ 477,509.00 Revised Contract Total $ 503,745.00 PERCENT CHANGE OF ORIGINAL CONTRACT 5.2% 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 ill apply. Recommended By: '~'Z l 2 t I Pro'ect Manager Date Approved By: l0 Department Head Date Accepted By: Contractor Date ENGINEERING TO: 541488-5347 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or.us C\Users\Stcvc\JOBS\1317 AP&R -Ashland Creek Park\Docurucnts\Changes\ACP Change Order 01