HomeMy WebLinkAbout2004-110 CONT Chg Order #16 - LTM Inc CITY OF ASHLAND
DEPARTMENT OF PUBLIC WORKS
PROJECT:
LOCATION:
CONTRACTOR:
CONTRACT CHANGE ORDER NO. 16
SISKIYOU BLVD/OTIA DATE: MAY 7, 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 b ;er:
Item No. Description Quantity Unit Price Amount
Item A Grinding and AC Preparation Lump Sum $2'1,500.00 $21,500.00
Original Contract $802,592.60
Total this Change Order $21,500.00
Previous Change Orders $34,766.50
Revised Contract Total $858,859.10
The time provided for completion of this contract is increased by no calendar days. This
document shall beco )m~ a/~m~~aE'E~4ne ~" ~./ t,.~e~'~/~'/
apply, c~/¢r~/ ct and all provisions of the contract will
Recommended By:
Approved By: z/,~. o¢'
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
G:\pub-wrks\eng\dept-admin\ENGINEER\PROJECT11999\99-38 Change Orders\Schedule A\99-38 Sch A CO 16.doc
REQUlSTION FORM
THIS IS A REQUEST FOR A:
[X ] Change Order (existing PO~ 3611 Schedule A)
C! T¥ OF
H LAN D
Date of Request:
Required Date of Delivery/Service:
Vendor Name: LTM INCORPORATED
Address: PO BOX 1145
City, State, Zip MEDFORD OR 9750'1
Phone:
Project Title: SISKIYOU BOULEVARD RECONSTRUCTION
Project Number: 99-38
Solicitation Process:
'[ ] Exempt ' ' [ ] 3'Written'~otes (copies'
at~ached)
[ ] Sole Source [ X ] Invitation to Bid (copies on
~ file)
[ '] Less than $5000 [ ] Request for Proposal (copies
I on file)
Services Only
Description
Siskiyou Blvd/Ashland St Reconstruction Project
!Change Orders 1 thru 15
Change Order 16 - Itemized Below (total $21,500.00)
Grinding and AC Preparation
Total Cost
Account Number 260.08.12.00.704200
~ ~ *Please attach the Odginal signed contract and Insurance Certificates.
Employee Signature: ~"~/ _~'~ ,~,~~-~-- Supervisorl Dept. Head Signature:
NOTE: By signing this requistiio~e'rm, Icex~F~tha the above request meets with Ctiyof Ashland SolicitiationProcessrequireme~s a~can be pn~videdwhennecessary.
/
G: Pubwrks~Eng\DeptAdmin\Engineer~Project~99-38 Schedule A Change Orders\99-38 CO 16 Sch A Requisition Updated on: 10113/03
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. SCH. A Job No.: 02271-42
Description of work: Grind AC & Prep
Date: 4/8/2004
LABOR 4/14/2004
LABOR TOTAL $0.00
EQUIPMENT
EQUIP. TOTAL $1,713.02
MATERIALS
MATERIAL TOTAL $0.00
SERVICES / MISC.
SERVICES TOTAL $0.00
....
Costs Subtotal (no markup)
Labor Mark-up 0%
Materials/Equipment/Services Mark-up 0%
$21.500.00
$0.00
$0.00
TOTAL AMOUNT DUE $21,500.00
Submitted by: ~ ~
.~','r'k-0'~r0T','~r- Construction Superintendent
Accepted by: ,,'~7~/,"Y~ Date: ~ /I'~o4 .
-,t. /, .,
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541 ) 488-5300
CITY RECORDER'S COPY
7/1 ~2003
Page 1 /3
L 03611
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
SHIP TO: Ashland Public Works
(541 ) 488-5587
51 WINBURN WAY
ASHLAND, OR 97520
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 9/9/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? No
;::~Quantity~ : :::;'unit; : ; :;i:~i .i: ~ :::], DescriPtion . i i . ,, Unit price . · :.~tlPrice ·
THIS IS A REVISED PURCHASE ORDER
: ::.::;:i' ::]~]:': :.;~::: ::.:. B~KE~PURcHASEORDER: i: ; .. :: :]'...:
Contract for the Sisk you Blvd Redesign 802,592.60
: ::'~:];:: i;:; ;::i' ;:::.;::;: .]~ :Pr°ject:99;38B]!;ThiS'r~eqbisitiOn is.:; ;:: ;;' . : ; ' : ;:;::: :':.. :
applicable to Bid Schedules A, C, & D
::: :::'.::] ::~::::]. °~IY, Bid:SChedUle BWill requirea ' . :
separate requisit!on.
];::: : ::].:': :Bid SChedule : :;' .] ]:' :" '" ]: · ]: :i ] i
Bid Schedule C o 660,266.62
· ;~ BiS]S~hed~leD:,..;. : ~.' .:: : ..;.: .;] ::;: .: :;174;600,00:
;: ...... ::Bidi :' ::. .: . ::':::; ~..':; :. ;::.: ..
Contract date: Au.qust 28, 2002
;Startdate:::::septemberg,:2002 ~:;:::;: :';': ":' : i ' :']:":::.: : : :'::::::::. ::;': ~:':; ::
Completion date: March 2003
:].:;~!; .:.;; :. ]!:]~:::!~:':;;' idSuran~brequiredlOnfile; : ] .: :;; : :;':'. ::' ];] ] . ;;.:]:;:;'; ::::::: ::.~.::;
Revised purchase order 01-22-2003. 18,000.00
: change:Or~erNo; 1;:CTBExcavation& ~ : ' ~ : :- ;- ' : ~ ... ': : ::-:
Haul Away
Change Order No. 2, Multiple Projects,
.See. attachedhst.:- 't-:~ : : t' '. L - 'ti , -
. ... . . . .
Revised purchase order 02-11-2003 960.00-
:: ';::.:":'::'~.::~:::~. ::? ;SChedUle;c .: .~:: :: ;: ; .:: .: ; .: :.: : : :'. :; ~ · '.' :: .'. · '
...:
Change Order No. 3 - Sign Post Credit
· : .:..change. Q~db~Nb;.4.:~.B.iLDirectional : :... :.: .:.-:
Markers
S U BTOTAL
BILL TO: T~
FREIGHT
TOTAL
E 260.08.12.00.704200 1,737,034.50
Authorized Signature
VENDOR COPY
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541 ) 488-5300
Page 2 / 3
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
sHIP TO: Ashland Public Works
(541) 488°5587
51 WINBURN WAY
ASHLAND, OR 97520,
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 9/9/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? No
Change Order No. 5 1,457.69.
(~i' ~i~ I{~ ~ ~irOWs ~Ei~
(B) Bid Item 38 Bicycle Lane Stencil
Change Order No. 6 - Joint Seal Bridge 1,471.13
Schedule A
Please see attached for descriptions of
Revised purchase order 05/13/2003 1,023.01
Change Order No. 10, Items A & B
Schedule D
Revised purchase order 08/01/2003 143.00
Change Order ¢11
Schedule C
Revised purchase order 08/01/2003 604.42
Change Order ¢2
Change Order 12, Items A and B
S U BTOTAL
BILL TO: T~
FREIGHT
TOTAL
Authorized Signature
VENDORCOPY
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541 ) 488-5300
Page 3 / 3
03611
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
SHIP TO: Ashland Public Works
(541 ) 488-5587
51 WINBURN WAY
ASHLAND, OR 97520
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 9/9/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: PauJa Brown
Confirming? No
· Revised purchase order 0!/15/2004 451.29
Change Order 3 - Electrical Boxes
Schedule A
Revised purchase order 01/22/2004 6,553.75
Change Order 14, Item A & B
Schedule A
Revised purchase order 03/05/2004 3,931.91
Change Order 4, Items A-C
Schedule A
*** This is a change order. ***
SUBTOTAL 1,737,034.50
BILL TO: Account Payable T~ 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 1,737,034.50
ASHLAND, OR 97520
~ ~Sign~(~
VENDOR COPY