HomeMy WebLinkAboutGeorge Harvey/8/Cool Creek Trail/-$54.67 Contract No:R -29657 Change Order No.: 008
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R -29657 Letting Date:02/09/2011
District:GREENFIELD DISTRICT AE:Goldner, Rob PE /S:Surber, Rob Status:Draft
Change Order Information Change Order No.: 008 EWA: Y or Force Acct: N
Date Generated: 00 /00 /0000 Date Approved: 00 /00 /0000
Reason Code: CHANGED COND, Construction Related
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Description: Extra Fence Added Around Utility Gate and Brackets on Bridge 11
Original Contract Amount 583,765.77 Original
Change Order Amount -54.67 Percent: -0.009
Total Previous Approved Changes 31,929.88 Percent: 5.470
Total Change To -Date 31,875.21 Percent: 5.461
Modified Contract Amount 615,640.98
Time Extension Information
Date Initiated 00 /00 /0000 Date Completed 00 /00 /0000
Original Contract Time SS Completion Date 00 /00 /0000 or SS Calendar/Work Days 0
SP Date 00 /00 /0000 or SP Days
(SS Standard Specification, SP Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value 0.00
Previous Time Approved SS Days by AE: DCE: SCE: DDCM:
SS Days SP Days Value
Revised Contract Time SS Completion Date 00 /00 /0000 or SS Calendar/Work Days 0
SS Date 00 /00 /0000 or SP Days 0
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Contract No:R -29657 Change Order No.: 008
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE: DCE: SCE: DDCM:
per Change Order) LE 250K-) LE 750K LE 2 M GT 2 M
(Days per Contract) (50 SS days 100 SS days 200 SS Days GT 200 SS days)
Verbal Approval Required? Y N If Y, by Date Issued
Total Change To- Date >5 Y N If Y Copy to Program Budget Manager
Scope /Design Recommendation Y N If Y, Referred to Project Manager(PM)
Required?
Date to PM Date Returned
Approval Authority Concurs with PM? Y N If Y, Concurrence by Date
If N,Resolution: Approved Disapproved
Resolved by Date
LPA Signatures Required? Y N If Y, Date to LPA Date Returned
FHWA Signatures Required? Y N If Y, Date to FHWA Date Returned
Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer Date
Comments:
Contract No:R -29657 INDIANA Date:12/06/2011
Change Order No:008 Department of Transportation Page: 3
Contract: R -29657
Project: 0600390 State:0600390
Change Order Nbr: 008
Change Order Description: Extra Fence Added Around Utility Gate and Brackets on Bridge
Reason Code: CHANGED COND, Construction Related
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0016 0600390 0016 205 -06931 TON 100.000 -2.000 C Amount:$ 200.00
Item Description: TEMPORARY CHECK DAM, REVETMENT RIPRAP
Supplemental Description1:
Supplemental Description2:
0025 0600390 0025 303 -07449 TON 59.450 46.050 C Amount:$ 2,737.67
Item Description: COMPACTED AGGREGATE, NO. 73
Supplemental Descriptionl:
Supplemental Description2:
0092 0600390 0092 105 -06807 LS 1,782.000 1.000 C Amount:$ 1,782.00
Item Description: ADDITIONAL
Supplemental Descriptionl: Additional fence added at gate for utility access area.
Supplemental Description2:
0093 0600390 0093 105 -06807 LS 1,101.000 1.000 C Amount:$ 1,101.00
Item Description: ADDITIONAL
Supplemental Descriptionl: Additional brackets for bridge railing on bridge.
Supplemental Description2:
Total Value for Change Order 008 -54.67
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
General or Standard Change Order Explanation
Chain Link Fence had to be added in order to place gate at the south end of the Utility access pad. Brackets had to be added to hang the bridge
railing on the bridge.
Change Order Explanation for Specific Line Item
It is the intent of the parties that this change order is full and complete compensation for the work describe above.
Notification and consent to this change order is hereby acknowledged.
Contractor: Signed By:
Date:
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Contract No:R -29657 INDIANA Date:12/06/2011
Change Order No:008 Department of Transportation Page: 4
APPROVED FOR LOCAL PUBLIC AGENCY
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(SIGNATURE) (TITLE) (DATE)
(SIGNATURE) (TITLE) (DATE)
SUBMITTED FOR CONSIDERATION
PENS
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status