HomeMy WebLinkAbout2004-012 CONT Chg Order #3 & # 13 - LTM Inc CITY OF ASHLAND
DEPARTMENT OF PUBLIC WORKS
PROJECT:
LOCATION'
CONTRACTOR:
CONTRACT CHANGE ORDER NO. 1:3
SISKIYOU BLVD/OTIA DATE: JANUARY 2, 2004
SISKIYOU BLVD. / 3RD STREET PROJECT NO.: 99-38 (Schedule A)
LTM INCORPORATED
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 Price Amount
CO1:3
Item A Sanitary Sewer Lateral Repair at 372 Main Street Lump Sum $427.59
Item B Curb Removal at Gresham Street Lump Sum $376.93
Item C Concrete Removal at Library Lump Sum $133.30
Item D Temporary removal of handicap ramps for sidewalk prep at 3rd St. Lump Sum $845.62
Item E Install drinking fountain at Gresham / Siskiyou Island Lump Sum $850.00
Original Contract
Total this Change Order
Previous Change Orders
Revised Contract Total
$802,592.60
$2,633.44
$13,190.31
$818,416.35
The time provided for completion of this contract is increased by no calendar days. This document
shall become an amen~d/~nt,]/~ the c,9~ct a/B~,,~rovisions of the contract will apply.,
Recommended By: ~ ,~ ~//~
E~gfneer f ~ ' Da, t'e ,
Approved By: n~~neer~~ - Date
Accepted By:
LTM Incorporated
PO Box 1145
Medford OR 97501
Contractor ' ~'--'"
Date
ENGINEERING Tel: 541-488-5347
20 E. Main Street Fax: 541-488-6006
Ashland, Oregon 97520 TTY: 800-735-2900
www.ashland.or.us
\\COMPAQ1\DATA\GOV~pub-wrks\eng\dept-admin\ENGINEER\PROJEC'I~1999\99-38 Change Orders\Schedule A\99-38 Sch A CO
A request for a Purchase Order
REQUISTION FORM
CITY OF
,,SHLAND
Date of Request:[ 01J0212004
THIS IS A REQUEST FOR A:
[ X ] Change Order (existing PO# 3611 Schedule A)
Required Date of Delivery/Service:
Vendor Name:
Address:
City, State, Zip
Phone:
Project Title:
Project Number:
LTM INCORPORATED
PO BOX 1145
MEDFORD OR 97501
SISKIYOU BOULEVARD RECONSTRUCTION
99-38
Solicitation Process:
[ ] Exempt ] 3 Wdtten Quotes (copies
attached)
] Sole Source [ X ] Invitation to Bid (copies on
file)
] Less than $5000 ] Request for Proposal (copies
on file)
Services Only
Description Total Cost
Siskiyou Blvd/Ashland St Reconstruction Project $ 802,592,60 Or!g!nat Contract Cost
Change Orders 1 thru 12 $ 13,190.31
Change Order 13 - Itemized Below (total $2,633.44)
Sanitary Sewer Lateral Repair at 372 Main Street $ ....... ' ' 427~9 .co.13 Item'A · · .. '.' ..'
Curb Removal at Gresham Street $ .......:. 376.93 CO 13 Item B
Concrete Removal at Library $ 133..30,. · CO.13. item C
Temporary Removal of Handicap Ramps for Sidewalk Prep at 3rd St. $ 845o62..; C° 13 item D
Install Drinking Fountain at Gresham / Siskiyou Island $ 850.00 CO 13 Item E
$ ' ' 818,416.35 REVISED CONTRACT
Account Number 260.08.12.00.704200
*Please attach the Odginal signed contract and Insurance Certifica~ A
Employee Signature: ~/~J //~.,/~,~._ Supervisor/Dept. Head Signature:
NOTE: By signing this're~uistiion fo~, I ce~'~a the above request meets with Ctiy of Ashland Solicitiation Process requirements ~ c~f~ be provided when necessao/.
G:Pubwrks\Eng\DeptAdrnin\Engineer~Project\99-38 Schedule A Change Orders\99-38 CO 13 Sch A Requisition.xls Updated on: 10/13/03
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-22
Description of work: Santitary Sewer Lateral Repair 372 Main St.
Date: 10/22/2003
LABOR
DATE'~".'.:.::.i :'~:.';CLASS ...... NAME' HOURS:::::;' ~:~:::HOURS::::: ;~;::~:'RATE RATE .,..~.~::.%:::~i:.~':~'....~..:.'i:.~: :i~:.~O~LS:.~'
10/22/03 Foreman McOlaffert 2.00 32.94 $65.88
10/22/03 Operator VanEss 1.00 32.37 $32.37
10/22/03 Laborer Luster 3.00 27.74 $83.22
10/22/03 Laborer McCulloug 3.00 27.74 $83.22
LABOR TOTAL $264.69
EQUIPMENT
EQUIP. NO. OF
DATE DESCRIPTION NO. HOURS RATE TOTAL
10/22/03 Pickup 20600 2.00 $8.25 $16.50
10/22/03 Pickup 20117 3.00 $8.25 $24.75
10/22/03 LTM Air Compressor 160088 3.00 $12.27 $36.81
10/22/03 JD 410E Backhoe 110082 1.00 $29.07 $29.07
EQUIP. TOTAL $107.13
MATERIALS
.' UNIT ]
DATE DESCRIPTION QTY. UNIT PRICE Discount TOTAL
MATERIAL TOTAL $0.00
SERVICES / MISC.
INV. !
DATE DESCRIPTION NO. AMOUNT TOTAL
SERVICES TOTAL $0.00
Costs Subtotal (no markup)
Labor Mark-up 15%
Materials/Equipment/Services Mark-up 15%
$371.82
$39.70
$16.07
Submitted by:
Accepted by:
TOTAL AMOUNT DUE
Superintendent
Date:
$427.59
LTM
DAILY EXTRA WORK REPORT
J~'ate:
Job Name:
Job No:
~reman;
CRAFT ST. OT.
EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION ISUPPLIER QTY.
MISCELLANEOUS (SUB, HAULERS, MOBS)
COMPANY EQUIPMENT
EQUIPMENT NO. 1 HOURS
I
RENTAL EQUIPMENT
EQUIPMENT NO, HOURS
2'
CUSTOMER SIGNATURE
H:,/Contracdng/.'enn's Reports, etc./Misc Forms/Daily Extra Wort< F~ei~or~
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-23
Description of work: Remove Curb @ Gresham
Date: 10/23/2003
LABOR
ST OT ST OT
DATE CLASS NAME HOURS HOURS RATE RATE TOTALS
10/23/03 Operator VanEss 1.00 32.37 $32.37
10/23/03 Foreman McClaffert 0.50 32.94 $16.47
10/23/03 Laborer Luster 3.00 27.74 $83.22
10/23/03 Operator VanEss 0.50 32.37 $16.19
LABOR TOTAL $148.25
EQUIPMENT
EQUIP. NO. OF
DATE DESCRIPTION NO. HOURS RATE TOTAL
10/23/03 JD 410E Backhoe 110082 1.00 $29.07 $29.07
10/23/03 Pickup 20117 3.00 $8.25 $24.75
10/23/03 Pickup 20600 0.50 $8.25 $4.13
10/23/03 JD 410E Backhoe 110082 0.50 $29.07 $14.54
10/23/03 LTM Air Compressor 160088 2.00 $12.27 $24.54~
EQUIP. TOTAL $97.02
MATERIALS
UNIT I
DATE DESCRIPTION QTY. UNIT PRICE Discount TOTAL
MATERIAL TOTAL $0.00
SERVICES / MISC.
INV.
DATE DESCRIPTION NO. AMOUNT TOTAL
10/23/03 Richard Siemers Trucking na $82.50 $82.50
$0.00
SERVICES TOTAL $82.50
Costs Subtotal (no markup)
Labor Mark-up 15%
Materials/Equipment/Services Mark-up 15%
$327.77
$22.24
$26,93
TOTAL AMOUNT DUE
$376.93
ate:
oreman;
LTM
DALLY EXTRA WORK REPORT
Job No:
CRAFT I ST. OT.
EMPLOYEE NAME RATEI HOURS HOURS DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
MISCELLANEOUS (SUB, HAULERS, MOBS}
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
H:,'Contracting/~enn's Reports, atc.,'Misc Forms/Daily Extra Work Repor~
LTM Incorporated
Time and MateriaLs Billing Summary
Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-24
Description of work: Concrete Removal @ Library
/'~N-y~,,-z ,.~ ,¢_--~¢¢/.4¢-5f Date: 11/12~2003
LABOR
ST OT ST OT
DATE CLASS NAME HOURS HOURS RAYE RATE TOTALS
11/12/03 Foreman McClaffert 0.50 32.94 $16.47
11/12/03 Operator Marez 1.00 32.37 $32.37
11/12/03 Laborer Luster 1.00 27.74 $27.74
LABOR TOTAL $76.58
EQUIPMENT
EQUIP. NO. OF
DATE DESCRIPTION NO. HOURS RATE TOTAL
11/12/03 Pickup 20600 0.50 $8.25 $4.13
11/12/03 JD 410E Backhoe 110081 1.00 $29.07 $29.07
11/12/03 LTM Air Compressor 160088 0.50 $12.27 $6.14
EQUIP. TOTAL $39.33
MATERIALS
UNIT [
DATE DESCRIPTION QTY. UNIT PRICE Discount TOTAL
MATERIAL TOTAL $0.00
SERVICES / MISC.
INV. [
DATE DESCRIPTION NO. AMOUNT TOTAL
SERVICES TOTAL $0.00
Costs Subtotal (no markup)
Labor Mark-up 15%
Materials/Equipment/Services Mark-up 15%
$115.91
$11.49
$5.90
Submitted by:
Accepted by:
J~struction
TOTAL AMOUNT DUE
Superintendent
Date:
$133.30
LTM
DALLY EXTRA WORK REPORT
Date: \\- \-7_- i5 ',~ Job Name:
oreman: /-'"). ,{~ C- ~\ 0..~ ~-c'~ Job No:
CRAFT ST. OT.
EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
,MISCELLANEOUS (SUB, HAULERS, MOBS)
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
tt oO~- k. t
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
H:/Contractin§/Jenn's Reports, etc./Misc Forms/Daily Extra Work Repcrt
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-25
Description of work: Remove AC Ramps, Prep Sidewalk
.,4,~,~r,- ~ .."¢,.~ ~¢.. /r~/ ~fz~ ~~- Date: 11/14/2003
LABOR
ST CT ST CT
DATE CLASS NAME HOURS HOURS RATE RATE TOTALS
11/14/03 Operator Marez 8.00 0.50 32.37 43.77 $280.85
11/14/03 Laborer Luster 8.00 27.74 $221.92
LABOR TOTAL $~02.77
EQUIPMENT
EQUIP. NO. OF
DATE DESCRIPTION NO. HOURS RATE TOTAL'
11/14/03 JD 410E Backhoe 110081 8.00 $29.07! $232.56
EQUIP. TOTAL $232.56
MATERIALS
UNIT I
DA, T,E DESCRIPTION QTY. UNIT PRICE DiscoUnt TOTAL
MATERIAL TOTAL $0.00
SERVICES / MISC.
INV. I
DA'i-E DESCRIPTION NO. AMOUNT TOTAL
SERVICES TOTAL $0.00
Costs Subtotal (no markup)
Labor Mark-up 15%
Materials/Equipment/Services Mark-up 15%
$735.33
$75.41
$34.88
Submitted by:
Accepted by:
TOTAL AMOUNT DUE
J ti~)n Superintendent
Date: /~. ~'7~ o_5
$845.62
LTM
DALLY EXTRA WORK REPORT
Date: ////(?//('~ ~ Job Name:
Foreman: _..J. ~)/cYt"~'.._.~ Job No:
CRAFT ST. OT.
EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
MISCELLANEOUS (SUB, HAULERS, MOBS)
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
H:/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-28
Description of work: Drinking Fountain @ Gateway Island
Date: 12/1/2003
LABOR 12/2/2003
ST OT ST OT
DATE CLASS NAME HOURS HOURS RATE RATE TOTALS
12/01/03 Foreman McClaffert 4.00 32.94 $131.76
12/01/03 Laborer Luster 6.00 27.74 $166.44
12/02/03 Foreman McClaffert 4.50 0.50 32.94 44.60 $170.53
12/02/03 Laborer Luster 6.00 27.74 $166.44
LABOR TOTAL $635.17
EQUIPMENT
EQUIP. NO. OF
DATE DESCRIPTION NO. HOURS RATE TOTAL
12/01/03 Pickup 20600 4.00 $8.25
12/02/03 Pickup 20600 5.00 $8.25
12/02/03 JD 410E Backhoe 110081 4.00 $29.07 $116.28
EQUIP. TOTAL $190.53
MATERIALS
UNIT I
DATE DESCRIPTION QTY. UNIT PRICE Discount TOTAL
MATERIAL TOTAL $0.00
SERVICES / MISC.
INV.
DATE DESCRIPTION NO. AMOUNT TOTAL
12/02/03 Rental Skidsteer na $148.00 $148.00
SERVICES TOTAL $148.00
Costs Subtotal (no markup)
Labor Mark-up 15%
Materials/Equipment/Services Mark-up 15%
$95.28
$5O.78
Submitted by:
TOTAL AMOUNT DUE
$1,119.76
?
Date:
· oreman:
LTM
DAILY EXTRA WORK REPORT
Job Name:
Job No:
CRAFT ST. OT,
EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
/
MISCELLANEOUS (SUB, HAULERS, MOBS)
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO, HOURS
H:/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
LTM
DAILY EXTRA WORK REPORT
Foreman: '~. {v'~.C~._ka~~,/ Job No:
/
C~FT ST. OT.
EMPLOYEE NAME ~TE HOURS HOURS DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
MISCELLANEOUS (SUB, HAULERS, MOBS)
CUSTOMER 81GNATURE
COMPANY EQUIPMENT
EQUIPMENT NO.. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
H:/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
CITY OF ASHLAND
DEPARTMENT OF PUBLIC WORKS
PROJECT:
LOCATION:
CONTRACTOR:
CONTRACT CHANGE ORDER NO. 3
SISKIYOU BOULEVARD CONSTRUCTION DATE: JANUARY 2, 2004
SISKIYOU BOULEVARD PROJECT NO.: 99-38, SCDL D
LTM INCORPORATED
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 Price Amount
CO 3 Electrical Boxes Lump Sum $451.29 $451.29
Original Contract
Total this Change Order
Previous Change Orders
Revised Contract Total
$174,600.00
$451.29
$962.42
$176,013.71
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. ,~/ //~ /~~/'~ e/~/
Recommended By:
Engineer /'~ ,/ ~ D
Approved By: E'/~~~/~i n~er Date/2_
Accepted By:
LTM Incorporated
PO Box 1145
Medford OR 97501
Contractor
Date
ENGINEERING
20 E. Main Street
AshLand, Oregon 97520
www.ash]and.or.us
Tel: 541488-5347
Fax: 541.488-6006
TTY: 800-735-2900
\\COMPAQ1\DATA\GOV~pub-wrks\eng\dept-admin\ENGINEER\PROJEC'R1999\99-38 Change Orders\Schedule D\99-38 CO Sc D 3.doc
A request for a Purchase Order
REQUISTION FORM
CITY OF
YkSHLAND
THIS IS A REQUEST FOR A:
[ X ] Change Order (existing PO# 3611 Schedule D)
Required Date of Delivery/Service: [ASAP .?'"' [
Vendor Name:
Address:
City, State, Zip
Phone:
Project Title:
Project Number:
LTM INCORPORATED
PO BOX 1145
MEDFORD OR 97501
SISKIYOU BOULEVARD RECONSTRUCTION
99-38
Solicitation Process:
Exempt ] 3 Written Quotes (copies
attached)
Sole Source X ] Invitation to Bid (copies on
file)
Less than $5000 ] Request for Proposal (copies
on file)
Services Only
Description Total Cost
Siskiyou Blvd/Ashland St Reconstruction Project $ ' '174,600.00. Original. Contract Cost
Change Orders No. 1 & 2 $ 962~42" Prior CJ~ahge Order
Change Order No. 3 Itemized Below (Total $451.29) ........
Electrical Boxes $ ''=' .... 451129 ItemA
$ '" '1'76,013.71 REVISED CONTRACT
Account Number 260.08.12.00,704200
*Please attach the Original signed contract and Insurance Certificates.
,f~J Head /~./~')~"1~
Employee Signature:~/~/'//~//~/~.--- Supervisor/Dept. Signature: requiremen/an~canbeprovidedwhenne~ceZssa~,~J.'~fo~
NOTE:By signing this ['equistiion f.~, l c. ef~ ~a the above request meets with Ctiy of Ashland Solicitiation Process
G:Pubwrks\Eng\99-38 CO 3 Sch D Requisition.xls Updated on: 7/15/02
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. SCH. D Job No.: 02271-604
Description of work: Electrical Boxes
Date: 1/14/1903
LABOR
ST OT ST OT I
DATE CLASS NAME HOURS HOURS RATE RATEI TOTALS
LABOR TOTAL $0.00
EQUIPMENT
EQUIP. NO. OF I
DATE DESCRIPTION NO. HOURS RATEI TOTAL
EQUIP. TOTAL $0.00
MATERIALS
UNIT
DATE DESCRIPTION QTY. UNIT PRICE Discount TOTAL
11/10/03 United Pipe electrical boxes 1 Ea $392.43 $392.43
MATERIAL TOTAL $392.43
SERVICES / MISC.
INV. I
DATE DESCRIPTION NO. AMOUNT TOTAL
SERVICES TOTAL $0.00
Submitted by:
Accepted by:
Costs Subtotal (no markup)
Labor Mark-up 15%
Materials/Equipment Mark-up 15%
o~n~~~....~..~/ TOTAL AMOUNT DUE
J - Construction Superintendent
$392.43
$o.oo
$58.86
$451.29
[I ii
MEDFORD - UNITED PIPE
UNITED Wuter & Wuste Wuter
PIPE&SUPPlY Equipment Company
541 -779-6721
REMIT TO:
P.O. BOX 6649O
PORTLAND, OR 97290-6490
INVOICE
INVOICE DATE I INVOICE NO.
11/25/03 6066576
B__RANOHI ACCOUNT NO. lORD. WRITER
5 542200 546
SOLD TO
LTM INC
PO BOX 1145
MEDFORD OR 97501-0231
Ihl,,h,,hhl,ll,,,,,,lllh,,,,I,l,,ll,,,,ll,l,,I,l,l,,,ll,I
SHIP TO
L T M INC
LAYDOWN YARD BETWEEM WALKER
AND STADIUM OFF ASHLAND STRT
ASHLAND, OR 97502
97502
(PAGE 1
DATE ORDERED I DATE SHIPPED I SHIPPED VIA I ORDERED BY I CUS'T~I O. NO. I JOB NAME I JOB NO.
11/10/03 11/24/03 ASHLAND HC232625~ SISKIYOU
ITEM I DESCRIPTION I QT~ ORDERED [QTY. SHIPPED[ QTY. B/O 1 UNIT PRICE [PERI DISCOUNT I AMOUNT
111348 N36BOX ELECT.CONCRETE 10/17 IN ( 2 2 40.0000 EA 80.00
122827 N36-61J CHR STL BOLTDOWN COVER ( 2 2 150.0000 EA 300.00
064231 N99-HDB CHRISTY BRASS BOLTS 2 2 6.2150 EA 12.43
(SET OF 2) ~,,. ~
BY: ....................
***** THANK YOU FOR YOUR ORDER ***** (S):SPECIAL ORDERED ITEMS ARE SUBJEC
*** YOUR BUSINESS IS APPRECIATED *** TO TERMS AND CONDITIONS ON BACK!
PLEASE CALL IF WE CAN BE OF ASSISTANCE.
549 JOHN HERMAN 541/779-6721
CODES: F= FREIGHT D= DELIVERY H=HANDLING E=EPA R=RESTOCKING M = MISCEL~NEOUS
TERMS I SUB-TOTAL I TAX I CODE OTHER CHARGES
If Pa±d By 12/10/03
Net Days 392.43 .00 .00 You May Deduct±pt
.00
TERMS & CONDITIONS ON REVERSE SIDE
873
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
RECORDER'S COPY
DATE
07/01/2003
Page 1 /3
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
SHIP TO: Ashland Public Works
(541) 488-5587
27-1/2 N MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 09/09/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? NO
Quantity Unit Description Unit Price Ext. Price
THIS IS A REVISED PURCHASE ORDER
BLANKET PURCHASE ORDER
Contract for the Siskiyou BIvd Redesign 802,592.60
Proiect 99-38B. This requisition is
applicable to Bid Schedules A, C, & D
only, Bid SChedule B will require a
separate requisition.
Bid Schedule A -
Bid Schedule C - 660,266.62
~ Bid Schedule D - 174,600.00
' Bd
Contract date: August 28, 2002
Start date September 9 2002
Completion date: March 2003
' nsurance required/On file
Revised purchase order 01-22-2003. 18,000.00
. Change Order No. 1 CTB Excavation &
Haul Away
Revised pUrchase order 01-22-2003 ' 13,964 08
Chan.qe Order No. 2, Multiple Projects,
See attached list.
Revised purchase order 02-11-2003 960.00-
Schedu e C
Change Order No. 3 - Siqn Post Credit
Change Order No 4 - B -D rect onal 970.10
Markers
S U BTOTAL
BILL TO: TAX
FREIGHT
TOTAL
E 260.08.12.00,704200 1,692,659.10
Authorized Signature
VENDOR COPY
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
07/01/2003
Page 2 / 3
03611
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
SHIP TO: Ashland Public Works
(541) 488-5587
27-1/2 N MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 09/09/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? No
Quantity I Unit Descr pt on Unit Price Ext. Price
Change Order No. 5 1 457.69.
(A) Bid Item 37 Arrows Marking :
(B) Bid Item 38 Bicycle Lane Stencil
· : (C~ Bid Item 39 Line Markings
Change Order No. 6 - Joint Seal Bridge 1 471.13
Revised purchase order 04/08/2003 : 9,955.57
Schedule A
Change orders No 1 to 9
Please see attached for descriptions of
change orders 1 throuqh 9.
Revised purchase order 05/13/2003 1,023.01
Schedule A
Change Order No. 10, Items A & B
ReviSed Purchase order 05/13/2003 358.00
Schedule D
Change Order No. 1
Revised purchase order 08/01/2003 143.00
Schedu e A
Chan.qe Order #11
Revised purchase order 08/01/2003 5'976 80
Schedule C
Change Order #7 :
Revised purchase order 08/01/2003 604.42
Schedule D :
Chan.qe Order #2
, Revised purchase order 11/18/2003 2 066.73
Chan.qe Order 12, Items A and B
S U BTOTAL
BILL TO: TAX
FREIGHT
TOTAL
Account Number Amount Account Number Amount
PA-GE.
Authorized Signature VENDOR COPY
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE 1
!
07/01/2003 j
Page 3 / 3
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
SHIP TO: Ashland Public Works
(541) 488-5587
27-1/2 N MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 09/09/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? NO
Quantity Unit :: Description '
Unit Price Ext. Price ,, ,
Revised purchase order 01/15/2004 451.29
SChedule D '
Chan.qe Order 3 - Electrical Boxes
Revised purchase order 01/15/2004 2,633.44
Schedule A
Chan.qe Order 13 (Items A-E) :
SUBTOTAL 1,692,659.10
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552~2028 TOTAL 1,692,659.10
ASHLAND, OR 97520
Signature
VENDOR COPY