HomeMy WebLinkAbout2006-063 CONT Chg Order #1 - Tobiasson Excavation
CITY OF ASHLAND
DEPARTMENT OF PUBLIC WORKS
CONTRACT CHANGE ORDER NO. 1
BEAR CREEK TRUNK SANITARY SEWER
PROJECT: PHASE 5
LOCATION: BEAR CREEK AREA
CONTRACTOR: TOBIASSON EXCAVATION 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:
DATE: MAY 8,2006
PROJECT NO.: 2003-05
Item No. Description Quantitv Unit Price Amount
CO 1.0 Extra work to connect to manhole. Lump Sum $2,064.00 $2,064.00
Provide top soil, seeding and ground cover
CO 1.1 over pipeline on R. Davis property. Lump Sum $1,500.00 $1,500.00
CO 1.2 Install flow dams in existing sewer line. Lump Sum $1,200.00 $1,200.00
Additional quantities: Bid items 11, 12, 15. $11,082.56
Total this Change Order
Previous Change Order
Original Contract
Revised Contract Total
$15,846.56
$0.00
$224,433.23
$240,279.79
The time provided for completion of this contract is increased by 30 calendar days. This
document shall become an amendment to the contract and all provisions of the contract will
apply.
Accepted By:
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T biasson Excavation Inc.
30 5 Highway 66
Ashland OR 97520
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Date
Recommended By:
Approved By:
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ENGINEERING
20 E. Main Street
Ashland, OreQon 97520
WWW.aShland.or.us
G:lpub-wrkslengldept-adminIENGINEERIPROJECT\2003105-03 Change Od 1 506.doc
Tel: 541-488-5347
Fax: 541-488-6006
TTY: 800-735-2900
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CITY 0 F
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
Page 1 / 1
CITY RECORDER'S COpy
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I 8/16/2005 _I ~ ~
VENDOR: 002814
TOBIASSON EXCAVATION INC
3055 HIGHWAY 66
ASHLAND, OR 97520
SHIP TO: Ashland Public Works
(541) 488-5587
51 WINBURN WAY
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date: 8/8/2005
Speciallnst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Jim Olson
Confirming? No
THIS IS A REVISED PURCHASE ORDER
BLANKET PURCHASE ORDER
Construction Services for the Bear
Creek Trunk Sewer Line Construction
Phase 5
224,433.23
Proiect 200305.120
Date of aQreement: June 21, 2005
BeQinninQ date: AUQust 8, 2005
Completion date: 10/05/2005
Insurance required/On file
Processed chanQe order OS/25/2006
Manhole connection, landscapinQ, flow
dam installation and additional
Quantities for items 11, 12, 15.
15,846.56
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
24027 .79
0.00
0.00
240,279.79
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orized Signature 'I:
VENDOR COPY
A request for a Purchase Order
REQUISTION FORM
CI T Y OF
ASHLAND
Date of ReqUest:_
THIS IS A REQUEST FOR A:
[Xl Change Order (existing PO# 6220)
Required Date of Delivery/Service:_
Vendor Name:
Address:
City, State, Zip
Phone:
Project Title:
Project Number:
TOBIASSON EXCAVATION INC.
3055 HIGHWAY 66
ASHLAND OR 97520
BEAR CREEK TRUNK SEWER LINE CONSTRUCTION PHASE 5
2003-05
Services Only
Description
Total Cost
BEAR CREEK TRUNK SEWER LINE CONSTRUCTION
Manhole connection, landscaping, flow dam installation and additional
quantities for items 11, 12, 15
Account Number
675.08.39.00.704200
'Please attach /he Original signed contract and Insurance Certificates.
Account Number
Employee Signature: Supervlsorl Depl Head Signature:
NOTE: By signing this "'Cfuistiion fonn, I certify tha the above request meets with C/iy of Ashland Solicilia/ion Process requireme
G:PubwrkslEngI03-05 Change Order 1 506.x1s
Updaled on: 7/15102