HomeMy WebLinkAboutGeorge Harvey Construction/CO1/ENG/Cool Creek Trail/inc 1,000 T
Contract No:R -29657 Change Order No.: 001
INDIANA Department of Transportation Page: 1 soft
Construction Change Order and Time Extension Summary ,t
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Contract Information Contract No.: R -29657 Letting Date:02/09 /2011
District:GREENFIELD DISTRICT AE:Goidner, Rob PE/S:Surber, Rab Status:Draft
Change Order Information Change Order No.: 001 EWA: Y or Force Acct: N
Date Generated: 00 /00 /0000 Date Approved: 00/00/0000
Reason Code: CHANGED COND, Construction Related
Description: Const. A signs added on Smokey Row Road
Original Contract Amount 583,765.77
Current Change Order Amount Percent: 0:000% 0000....
Total Previous Approved Changes 0.00 Percent: 0.000 °/a
Total Change To -Date 0.00 Percent: 0.000
Modified Contract Amount 583,765.77
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)
me ment Description:
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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.: 001
INDIANA Department of Transportation Page: 2
Construction Change Order and Time Extension Summary
Review and Approval Information
Required Approval Authority AE: DCE: SCE: DDCM:
($perChangeOrder) LE$ 250K-) LE$750K- LE$2M-- GT$2M
(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 Retumed
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 Retumed
FHWA Signatures Required? Y N ff Y, Date to FHWA Date Returned
Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field.Engineer Date
Comments:
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Contract No:R -29657 INDIANA Date:04/18/2011
Change Order No:001 Department of Transportation Page: 3
Contract: R -29657
Project: 0600390 State:0600390
Change Order Nbr: 001
Change Order Description: Const. A signs added on Smokey Row Road
Reason Code: CHANGED COND. Construction Related
CLN PCN PLN horn Code Unll Unit Price CO Qty Comment Amount Change
0084 0600390 0084 801 -06640 EACH 250.000 4 000 C Amount :S 1.000.(x1
(tom Description: CONSTRUCTION SIGN, A
Supplemental Descnptionl: signs added due to sidewalk removal on Smokey Road
Supplemental Description2:
Total Value for Change Order 001 S 1.000.00
Whereas. the Standard Specifications for this contract provides for such work to bo perforated., the following change is rocornneended.
Change Order Explanation for Spectflc Lino Item
R is the intent of the parties that this Change orb is full and complete compensation for the worst desaibe above
Notification and consent to this change order is nereby advrowiedged
Contractor. Signed By
Date:
NOTE Other required State and FHWA signatures will be obtained electronically through the Sifaltanager system
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Contract No:R -29657 INDIANA Date:04/18/2011
Change Order No:001 Department of Transportation Page: 4
APPROVED FOR LOCAL PUBLIC AGENCY
C iry /L)4 bur ,i ,e. y z7 i/
SIGNATURE) (TITLE) (DAT
(SIGNATURE) (TITLE) (DATE)
SUBMITTED FOR CONSIDERATION
PENS
APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status
5240 E. 25th Street
Indianapolis. IN 46218
-'1 N 0t A N A Indiana Sign Barricade, Inc. is a
317-377-8000
st)jt; "fi It `i(IEY Certified DBE /WBE 317 3774008
www. Indii naSB.com
Contract No: R -29657 Submitted by: Steve Apple
Location: Cool Creek North Trail,Hamitton Co. Cell Phone: 317 373 -9368
Ling Date: February 9, 2011 sangleOlndianaSB.com
Complotioo Dato: November 15, 2012
Intermediate Date: October 15. 2011 Page 1 of 1
UNIT
ITEM DESCRIPTION QUANTITY UNIT PRICE EXTENSION
EWA 1 1 Construction Sign A 4.00 t=A _250.00 1.000:00
Total 1,
NOTES: 1) Prices include irstiat installation and removal upon completion ttvu October 15. 20i t
Equipment needed beyond these dates wih be bared on a pro-rala basis
Daily mairrtenanae andtor ralocaban by others,
2) Prices may not be honored if a subcontract for this work is not received within 30 calenoar days from date of bid.
3) MB to maintain lights and repair damaged equipment as needed.
4) The Traffic Control Device Report is NOT inducted.
5) Alt equipment ordered and dertveres to ate but not paid by owner will be paid by the Prime Contractor.
6) A minimum 5 business day notice is required for all operations, except sign Installation wt+kh requires 8 business days.
7) Rental items F.O.B. 138 Indy yard: Drum SO 55tday/each: Light $0.35Adayreach (Delivery quoted upon request)
8) No Retainage is to be withheld from progress payments. No taxes. bonds. or permits are included.
8) loo EEO Trainee Hours are inctt ea.
f i
_.L �j a Date: April 13. 2011
/Janet L utt_ Press eat
Accepted: Date:
Printed Name:
Company Name: George R. Harvey 6 Son Inc.
An Equal Opponuniry Employer
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