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Home My WebLink About2003-213 CONT Chg Order #12- LTM Inc CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS PROJECT: LOCATION: CONTRACTOR: CONTRACT CHANGE ORDER NO. 12 SISKIYOU BLVD/OTIA DATE: OCTOBER 13, 2003 SISKIYOU BLVD. / 3TM 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 CO 12 Item A Extra Sidewalk Removal Gresham & Hargadine Lump Sum $1,097.58 Item B Extra Concrete Removal at Gresham Lump Sum $969.15 Original Contract Total this Change Order Previous Change Orders Revised Contract Total $802,592.60 $2,O66.73 $11,123.58 $815,782.91 The time provided for completion of this contract is increased by no calendar days. This document shall become an amend~m..,.~Ct t~. the c/~ract a~2a. II~ provisions of the contract will apply.. Recommended By: ~,~," /// ~//,.-~-~ En~ Date/ Approved By: ~ ~,~' ~n ineer z Date g Accepted By: LTM Incorporated PO Box 1 145 Medford OR 97501 Date ENGINEERING Tel: 541488-5347 20 E Main Street Fax: ,541488~005 Ashland' Oreg°n §'~www ash[and or us 520 TTY:800-735-2900 \/COMPAQ 1 \DATA/GOV~pub-wrks\eng\dept-admin\ENGINEER\P ROJ ECI~1999\99-38 Change Orders\Schedule A\99-38 Sch A CO CITY OF ,-ASHLAND A request for a Purchase Order REQUISTION FORM THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO¢ 3611 Schedule A) Date of Request: Required Date of Delivery/Service: Vendor Name: LTM INCORPORATED Address: PO BOX 1145 City, State, Zip MEDFORD OR 97501 Phone: Project Title: SISKIYOU BOULEVARD RECONSTRUCTION Project Number: 99-38 Solicitation Process: ] Exempt ] 3 Wdtten Quotes (copies Services Only Description Total Cost Siskiyou Blvd/Ashland St Reconstruction Project ' 3hange Orders 1 thru 10 $ 10,980.58 Change Order 11 $ 143.00 Change Order 12 - Itemized Below Item A - Extra SidewaIk Removal at Gresham & Hargadine $ 1,097.$8 CO 12 gemA Item B - Extra Concrete Removal at Gresham Street $ 969~'15 c~ !21!ern B Account Number 260.08.12.00.704200 Employee Signature: Super~isorl Dept. Head Signature: GPu bwrks\E ng\DeptAdmi¢lEngJnee P,P r ojecR99 38 Schedule A Change Orders/99 38 CO 12 Sch A Requisition xls Updated on 10/13~33 LTM Incorporated Time and Materials Billing Summary Project Name: SISKIYOU BLVD. SCH A Job No~: 02271-19 Description of work: Extra Concrete Removal Date: 9/11/2003 LABOR 9/24/2003 ST OT ST OT DATE CLASS NAME HOURS HouRs RATE RATE TOTALS 09/11/03 Foreman Easter 2.00 32.94 $65.88 09/11/03 Laborer Luster 2.00 27.74 $55.48 09/24/03 Laborer Fay 2.50 27.74 $69.35 09/24/03 Operator Vaness 2.00 32.37 $64.74 09/24/03 Laborer McCullou~ 2.00 27.74 $55.48 09/24/03 Foreman Easter 2.50 32.94 $82.35 LABOR TOTAL $393.28 EQUIPMENT , EQUIP. NO. OF DATE DESCRIPTION NO. HOURS RATE TOTAL 09/11/03 JD410E Backhoe 110081 2.0¢ $29.07 $58.14 09/11/03 Pickup 20075 2.00 $8.25 $16.50 09/24/03 JD 410E Backhoe 110082 2.00 $29.07 $58.14 09/24/03 JD 410E Backhoe 110083 2.50 $29.07 $72.68 09/24/03 Pickup 20075 2.00 $8.25 $16.50 EQUIP. TOTAL $22'1.96 MATERIALS , UNIT ,DATE DESCRIPTION I QTY~ 1 UNIT I PRICE I DisC°untl' TOTAL I / / [MATERIAL TOTAL I $0-001 SERVICES I MISC. INV. DATE DESCRIPTION NO. AMOUNT TOTAL 09/11/03 LeaserTruck 2.5hfs na $162.50 $162.50 09/24/03 Lyons Trucking 1hr na $65.00 $65.00 SERVICES TOTAL $227.50 Costs Subtotal (no markup) $842.74 Labor Mark-up 15% $58.99 Materials/Equipment/Services Mark-up 15% $67.42 Submitted by: TOTAL AMOUNT DUE $969.15 LTM Incorporated Time and Materials Billing Summary Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-18 Description of work: Extra Sidewalk Removat Date: 9/10/2003 LABOR 9/18/2003 ST OT ST OT DATE CLASS NAME HOURS HOURS RATE RATE TOTALS 09/10/03 Laborer Wilkerson 4.00 27.74 $110.96 09/10/03 Operator VanEss 4.00 32.37 $129.48 09/10/03 ,Foreman Easter 2.00 32.94 $65.88 09/15/03 iOperator VanEss 2.00 32.37 $64.74 09/15/03 Laborer Wilkerson 2.00 27.7, $55.48 09/15/03 Teamster Elam 2.75 24.5! $67.62 LABOR TOTAL $494.16 EQUIPMENT EQUIP, NO. OF DATE ; : DESCRIPTION NO. HOURS RATE TOTAL 09/10/03 Pickup 20075 2.00 $8.25 $16.50 09/10/03 JD 410E Backhoe 110081 4.00 $29.07 $116.28 09/15/03 JD 410E Backhoe 110082 2.00 $29.07 $58.14 09/15/03 LTM Transfer 31083 2.75 $47.94 $131.84 EQUIP. TOTAL $322.76 MATERIALS UNIT: MATERIAL TOTAL $0.00 SERVICES / MISC. 09n 5/031LoPera Leaser I I I NO. 1AMOUNTI 25243 / $137.50I ISERVICES TOTAL $137.50] $137.50/ Costs Subtotal (no markup) Labor Mark-up 15% Matedals/EquipmentJServices Mark-up 15% $954.42 $74.12 $69.04 Submitted by: Accepted by: Jo)~o,llr - ~struction Superintendent Date: $1,097.58 ate: LTM DAILY EXTRA WORK REPORT 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. I HOURS / RENTAL EQUIPMENT EQUIPMENT NO. HOURS H:/Con[racting/'Jenn's Reports. e[c./MJsc Forms/Daily Ex[rs Work Report LTM DAILY EXTRA WORK REPORT Job Name: CRAFT ST. CT. EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK T__ MATERIALS USED DESCRIPTION SUPPLIER MISCELLANEOUS (SUB, HAULERS, MOBS) COMPANY EQUIPMENT EQUIPMENT NO, HOURS RENTAL EQUIPMENT EQUIPMENT NO. HOURS CUSTOMER SIGNATURE H:,'Contracting/Jenn's Resor[s, eIc,,'Misc Forms/Daily Ex[rs ',a/ork Repor~ ate: LTM DALLY EXTRA WORK REPORT ~'~/¢~ D~ Job Name: ,~.~"~/7~¢~2___ Job No: ,~2Z ?/ '.'7 CRAFT ST. OT. EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK MATERIALS USED DESCRIPTION ISUPPLIER MISCELLANEOUS (SUE, HAULERS, MOBS) COMPANY EQUIPMENT EQUIPMENT NO. HOURS RENTAL EQUIPMENT/ EQU PMENTNO. / HOURS CUSTOMERSIGNATURE ......... Rt Page 1 / 2 ,?CITY OF ASHLAND CITY RECORDEf S COPY 20 E MAIN ST. DATE PO NUMBER ASHLAND, OR 97520 07/01/2003 03611 ~~ (541) 488-5300 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 FOB Point: Terms: Net 10th of Month Req. Del. Date: 09/09/2002 Special Inst: SHIP TO: Ashland Public Works (541) 488-5587 27-1/2 N MAIN STREET ASHLAND, OR 97520 Req. No.: Dept,: PUBLIC WORKS Contact: Paula Brown Confirming? NO Qu~antity U~nit Description Unit Price Ext. Price THIS IS A REVISED PURCHASE ORDER BLANKET PURCHASE ORDER Contract for the Siskiyou Blvd Redesign 802,592.6 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 - 660,266.6 Bid Schedule D - 174,600.g Bid Contract date: August 28, 2002 Start date: September 9, 2002 Completion date: March 2003 Insurance required/On file Revised purchase order 01-22~2003. 18,000.£ Chan~e Order No. 1, CTB Excavation & Haul Awav Revised purchase order 01-22-2003, 13,964.£ Chan~e Order No. 2, Mu tiCe Proiects, See attached list. Revised purchase order 02-11-2003 960.( Schedule C Chanqe Order No. 3 - Si~n Post Credit Chancie Order No. 4 - Bi-Directional 970/ Markers SUBTOTAL BILL TO: TAX FREIGHT TOTAL Account Number Amount Account Number Amount E 260.08.12.00.704200 1,68~9,574.37 Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 FOB Point: Terms: Net 10th of Month Req. Del. Date: 09/09/2002 Special Inst: DATE 07/01/2003 Page 2 / 2 PO NUMBER 03611 SHIP TO: Ashland Public Works (541) 488-5587 2%1/2 N MAIN STREET ASHLAND, OR 97520 Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Quantity Description Change Order No. 5 (A) Bid Item 37 Arrows Marking (1~) Bid Item 38 Bicycle Lane Stencil (C) Bid Item 39 Line Markings Change Order No. 6 - Joint Seal Bridge Revised purchase order 04/08/2003 Schedule A Change orders No. 1 to 9 Please see a[tached for descriptions of change orders 1 through 9. Revised purchase order 05/13/2003 Schedule A Change Order No. 10, Items A & B Revised purchase order 05/13/2003 Schedule D Change Order No. 1 Revised purchase order 08/01/2003 Schedule A Change Order #11 Revised purchase order 08/01/2003 Schedule C Chancre Order #7 Revised purchase order 08/01/2003 Schedule D Change Order #2 Revised purchase order 11/18/2003 Change Order 12, Items A and B Unit Price BILL TO: Account Payable 20 EAST MAIN ST 541-552-2028 ASHLAND, OR 97520 SUBTOTAL TAX FREIGHT TOTAL Ext. Price 1,457.69- 1,471.13 9,955,57 1,023.01 358.00 143.00 5,976.80 604.42 2,066.73 11689,5~4.37 0.00 0.00 1,689,574.37 Account Number Amount Account Number Amount .~at horiz~e¢~g~ature VENDOR COPY