HomeMy WebLinkAbout2009-146 CONT Chg Order #1 - Terrasurvey Inc
CITY OF ASHLAND
DEPARTMENT OF PUBLIC WORKS
CONTRACT CHANGE ORDER NO. 1
PROJECT:
LOCATION:
Nevada St Sewer Pump Bypass
Nevada Street
DATE: July 7,2009
PROJECT NO.: 2008-23
CONTRACTOR: Terrasurvey, 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:
Item No. Description Quantitv Unit Price Amount
Locate and mark boundary of
C01 Citv propertv All $375.00 $375.00
Total.this Change Order
Previous Change Order
Revised Contract Total
$375.00
o
$2,875.00
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.
~
t Surveyor
'\'{~~~.
7/C)//Or
Date
Recommended By:
Approved By:
-
,/t)/C:J<f
Date
Aooepted By:
" /
~ ~h ~_A___
T e.rrasurvey Inc. -
Dat] /~/ lE>>1
ENGINEERING
20 E. Main Street
Ashland, O'!'!jon 97520
www.ashland.or.us
G:lpub,wrkslengldept-adminIENGINEERIPROJECT\2008108,23 Terrasurvey Change Orner 1.doc
Tel: 541-488-5347
Fax: 541-488-6006
TTY: 800-735-2900
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Page 1 /1
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CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
CITY REC
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2/10/2009
08800
VENDOR: 003354
TERRASURVEY INC
274 FOURTH STREET
ASHLAND, OR 97520
SHIP TO: Ashland Public Works
(541) 488-5587
51 WINBURN WAY
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Depl.: PUBLIC WORKS
Contact: Jim Olson
Confirming? No
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THIS IS A REVISED PURCHASE ORDER
Contract for primary flexible surveyinrl , 2,500.00
- topographic survey for the Nevada
Street Sewer by-pass Project 2008-23
RFP
Contract for Personal Services -
Date of agreement: January 22, 2009
Beginning date: February 1, 2009
Completion date: June 30, 2011
Contract may be extended for two
additional one year terms
Insurance required/On file
Not to exceed $20,000 for both purchase
orders ($17,500/PO 08801 and $2,500/PO
08800) per attached fee schedule for
initial 29-month contract
Approved by City Council February 17,
2009
Processed change order 06/30/2009, 7 375,00
Change Order No: 1: Locate and mark r'/ :;2- t2-- tfJi
boundary of City property
SUBTOTAL 2875.00
BILL TO: Account Payable TAX 0,00
20 EAST MAIN ST FREIGHT 0,00
541-552-2028 , TOTAL 2,875,00
ASHLAND, OR 97520
~~-:{.A:ccountTNumtler:,:~C~ ~~~'~~~roject1'NTJ~mH'-'er~}.;~tJ~ ~,7>'~:~~'-'AmcfiJf1t:":~_''''~ ..:Ji :'J:!&.:C"'o.iinTNumBe~1';.T:-,~ ;!3~rgIec~u~~~~i~Z; i42.~~~TAn{oth1f~i~.sJ
E 675.08.17,00,70420 E 200823,100 2 300.00
E 675.08.37.00.70420 E 200823.100 575.00
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A~orized Si atur
VENDOR COPY
I FORM #121
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P,ERSONAL.SER\tICES
lL-....:_-::....:....:.._::.-~:-::..-..:.;..:.;......~ ;"T"--",.' f
CHANGE ORDER/CONTRACT AMENDMENT
APPROVAL REQUEST FORM
CITY OF
ASHLAND
Description of Change Order I Contract Amendment to original contract
Consultant: ~
';- c,.e-r Y 4- ;Z-u-r- y ~
Purchase Order Number: cf/ if fi3 & 0
Description: / .9 ~ <l2: ~V'L~
0-# <!' .t.~U' <Z/?Le. c:ur ~
tCllf c!..c. ~ ~-ypJ?-<,A'" "d-
~er attached contract amendment '
I-~, '_~" L.....' .':" _ '-:---.-~:-:'____'7~_-;-c:"-~ '~~~:~~"." -" " ._-::.7'\
GoiitractA'mendment :foh~ERSONALcSER.vIGES
------'___...__.. __n_______ __ __._'_.. __ ____ _...____,__. __ . '0 ____~_._ "___
Original contract amount
:;2?~.
/V" / A
CLeJ
$
Total amount of previous contract amendments
Amount of this contract amendment
..:3' 7 -cr. ,!-.<!)
,;;;.6 75/~
TOTAL AMOUNT OF CONTRACT
$
Is the total aggregate cost change for the Personal Services contract
less than or equal to 25%' of the original contract amount?
: motall!ani@lit?fl~I1~i1gg~9fc!~(;;, :::.:~~
,,1,'$', ' ';'-. .;., '., ';'>:::_",',".,,'t-~-;:~.:~
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,
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% of original contract
r ~ % of original contract
/' /' '5-- % of original contract
YES ~O _ Not Applicable_
If "No", City Council approval is required, City Council approval was received on
(Date)
Are there any applicable performance or payment bonds and insurance coverages
that need to be adjusted to account for the change in the contract amount? YES _ NO ~ Not Applicable
Contract amendments for personal services are subject to the following conditions: The original contract imposes binding obligation on
the parties covering the terms and conditions regarding changes in the work; or the amended contract does not substantially alter the
scope or nature of the project. Has either of these conditions been met? /
YES_ NO_ NfA
If "NO", Council approval is required. Council approval received on
(Date)
Was the original contract approved by the City Council, or is it exempt?
YES (Approved by Council) NO (ExemptlNot Required)
(Date)
<-f'<JtL.....
Prepared by:
tf:;r,- Va
Please circle:
(Reason for exemption)
Department:
~ / Not Approved
~:1 er I'
Lee Tuneberg
Date: ?~?
y(}'~'-z. -;?
Date:
tJ?~ Ie?
Form #11 - Contract Amendment Approval Request Fo m, Page 1 of 1, 7/9/2009
CITY OF
ASHLAND
A request for a Purchase Order
REQUtSTION FORM
Date of ReqUest:C"7m20~1
THIS IS A REQUEST FOR A:
Required Date of Deliverylservice:I[~:..._~ 11
[X ] Change Order (existing PO# 8800 )
Vendor Name:
Address:
City, State, Zip
Phone:
Project Title:
Project Number:
Terrasurvey Inc.
274 Fourth 51.
Ashland, OR 97520
482.6474
Nevada Street Sewer Pump Station Bypass
2008-23
Services Only Solicitation Process:
[] Exempt [ J 3 Written Quotes (copies
attached)
[ ] Sole Source [Xl Invilation to Bid (copies on
file)
[1 Less than $5000 [ ] Request for Proposal (copies
on file)
Descri tion
Total Cost
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'~:i;: :2'15'00:00 '.QHg@al~C06tia6~ c6Jt.>:td
Change Order No.1
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ro-'- ..;\a-'~':::r ~t_ :11Cffi;,~-,,:S'7~:7':z.?'r-":~~~~1r;':)~:}. :7:'7~\":J?l
~$;'~ "~:J2!87.5:00r_;_:~_;REVISE5~tONTRACT'-\j
Account Number
675.08.17.00.704200 (80%)
675.08.37.00.704200 (20%)
Employee Signature:
NOTE: By signing !hi f quistiion form,
.Please attach the Original s1gne~ contact and Insurance Certificate~. 1
Supervlsorl Dept. Head Signature: . ~; ~ Q ~'--
certify tha the above request meets with Cliy of Ashland SoIicit/ation Process requirements and can be provided when necessary.
~
G:~ub-wfl\s\eng\dept-admin\ENGINEER\PROJECT\2008108.23 Terra Req Chang~ Order 1.xls
Updated on; 10f13103