HomeMy WebLinkAbout2004-045 CONT Chg Order #1 - DA Boldt ConstructionD.A. BOLDT COlXlSTRUCTION Co.
I'.O. Box 998, ASHLAND, OFtECON 97520 · 541/482-4865 FAX: 541/482-7190 · DABOLDT@I"IlND.NET · CCB#31003
Change Order #1
Owner: City of Ashland
20 E. Main St.
Ashland, Oregon
Project: Pioneer Hall Restrooms Remodel
Ashland Oregon
Date Original Comract: December 18, 2003
Date this Change Order: January 29, 2004
AH work specified in this Change Order will be performed under the same terms
and conditions as specified in the Original Comract. This Change Order becomes
a part of and in conformance with the original Contract.
We hereby agree to make the changes specified below:
1. Water damage repair Add $
Repair to floor resulting from water intrusion
2. Men's Restroom Door Add $
Relocate door for handicap access per Dale Peters
3. Plumbing Add $
Add installation of second lav in women's restroom
Lav and faucet provided by Owner
4. Door locks and hardware Deduct $
Provided by Owner
1,425.00
53.00
785.00
(120.00)
Original Comract Amount
Total this Change Order
Revised Contract Total
The Contract construction time is extended by 3 day(s) by this change order.
Contractor:
Darre'll~' Boldt, Presidem
Owner(s):
Dale Peters
Facility Maintenance
City of Ashland
$
$
$
14,388.00
2,143.00
16,531.00
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
CiTY RECORDER'S COPY
DATE
12/19/2003
Page 1 / 1
[ 04723 J
VENDOR: 002799
D A BOLDT CONSTRUCTION
PO BOX 998
ASHLAND, OR 97520
SHIP TO: Ashland Public Works
(541) 488-5587
27-1/2 N MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown / Dale Peters
Confirming? No
Quantity Unit ., Description , Uni~ Price Ext. Price
THIS IS A REVISED PURCHASE ORDER
Remodel existing two restrooms to 14,388.00
create two new ADA compliant restrooms
- Pioneer Hall. Includes allowance of
$120.00 for door Iocksets and hardware.
: CSK
Date of a.qreement: December 18, 2003
Be.qinnin.q date: December 22, 2003
Completion date: February 20, 2004
Insurance requ red/On f e
Revised purchase order 02/13/2004 2,143.00
Chan,qe Order ~1
Floor reconstruction
:
SUBTOTAL 16,531.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 16,531.00
ASHLAND, OR 97520
Account Number Amount Account Number Amount
E 710.08.24.00.602320 16,531.00
Author~t Signature
!
VENDOR COPY
REQUISITION FORM
THIS REQUEST IS A:
{~ Change Order(existing PO # __
CITY OF
-ASHLAND
Date of Request: I/3
Required Date of Delivery/Service:
Vendor Name:
Address:
City, State, Zip:
Phone:
Fax Number
Deliver Location
Services Only
Description Total Cost Solicitation Process:
[] Exempt [] 3 Written Quotes
(copies attached)
[] Sole Source [] Invitation to Bid
(copies on file)
~ Less than [] Request for
$5000 Proposal (copies on file)
Account NumberT./_O_- _~_ -Z_~- _~_0. ~ZZ_ o
*P/ease attach the Origina/ signed contract and Insurance certificate.
Materials Only
Item # Quantity Unit Description Unit Cost Total Cost
Account Number
*Please attach the quotes.
Employee Signatur~ Supervisor/Dept. Head Signature:
NOTE: By signing this ~ cer~fy that the above request meets the City of Ashland Solicitation Process requirements and can be provided
when necessary.
G:Finance\Procedure~AP\Forms\8_Requisition form.doc Updated on:07/15/02