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HomeMy WebLinkAbout2011-255 CONT Chg Order #1 - Blackline Inc CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER NO. PROJECT 7 og + t F,. ka "mss"s � DATE:�09a LOCATION CONTRACTOR. PROJECT NO.:':," {j, I� ;_ '�i�-�:.._ �� �,� n, yIteIf :T]Oli.., t+ i -�` ,,-._ Ph -(Ziianti si TJntY Fnpe,. Item#1 Strawberry Ln, Scenic to Granite 408 1.26 Item#2 Item#3 °' Item#4 Item#5 0 . Total this Change Order s ry ST4;lJ8 Previous Change Order Original Contract Total $` 110 p0 Revised Contract Total S 75,124.08 PERCENT CHANGE OF ORIGINAL CONTRACT 0�% This was completed on Friday 09/23/2 1 Recommended By: 9/27/2011 Pro'ect Man Date Approved By: wcl O i 9/P-i; Public Works Director Date Accepted By: Contractor Representative Z7 Date ENGINEERING Td:5414883347 20 E.Main SC Fu:M1488-6006 Ashlmd.Oregon 97520 TTY;800-7352900 www.eshlmdm.us ,�, ClUsersVcmti fa+DawolaadsiBlecklim_Chenee //11 Page 1 / 1 �. CITY O F C11 y ,�„v©qD�R ASHLAND DATE 7�.:PO NUMBER . . 20 E MAIN ST. 8/18/2011 10396 ASHLAND, OR 97520 (541)488-5300 VENDOR: 008572 SHIP To: Ashland Public Works BLACKLINE INC (541)488-5587 PMB 196 13023 NE HWY 99 STE 7 51 WINBURN WAY VANCOUVER, WA 98686 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del.Date: contact: Mike Faught-John Peterson Special Inst: Confirming? NO . Quanfi Unit ��.�. ..�.<- � _. � Descri tion .. � :.� � - .'. _.' Unit Price Eat:Price• .. THIS IS A REVISED PURCHASE ORDER 2001 Street Slurry Seal 74,610.00 Public Improvement Contract Contract start date: August 5, 2011 Contract completion date: Sept 30, 2011 Insurance required/On file Processed change order 09/2812011 514.08 Change Order No. 1 Strawberry Lane, Scenic to Granite SUBTOTAL 75124.08 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 75,124.08 ASHLAND, OR 97520 ;AccounfNumlier„ � � '�- Project Numtier r.' � . '.Amount' � .� Account Number .:" ° Project Number '_� ,.: Amount . ., E 260.08.12.00.704100 E 201123.120 75 124.08 y' Autotized Signature VENDORCOPY CITY OF ASHLAND A request for a Purchase Order REQUISTION FORM Date of Request: s/za/zo11 THIS IS A REQUEST FORA: Required Date of Delivery/Service: (X ] Change Order(existing PO#10396) Vendor Name: Blackline,Inc. Address: PMB 196,13023 NE Hwy 99,Ste.7 City, State, Zip Vancouver,WA 98686 Phone: (360)225-1080 fax(360)225.6472 Project Title: 2011 Street Slurry Seals Project Number: 2011-23 Services Only Solicitation Process: [ ] Exempt l 1 3 Written Quotes(copies attached) [ J Sole Source 1 I Invitation to Bid(copies on file) [ ] Less than$5000 [ I Request for Proposal(copies on file) Description Total Cost g$ 7_4,610.00 OriginaFContraM Cost Change Order No.1 $ 514.08 $ 75,124.08 REVISED CONTRACT Account Number 260.08.12.00.704100 'Please attach me Original signed contra n and Insurance Certificates.. Employee Signature: Supervisor/Dept.Head Signature: N\ ca-SG V NOTE: By signinggrequisNon fo ,I certify the the above request meets with Cay or Ashland Solicit/ation Process requirements and can be provided when necessary. G:Pulrmik s)EttglDeptAdminTngineeeProjerll9938 Schedde A Change OrdersOacune Change order Requisition 2011.Ids Updated on:10/13/03