HomeMy WebLinkAboutGeorge Harvey Construction/CO2/ENG/Cool Creek Trails/inc. 4,465 Contract No :R -29657 Change Order No.: 002
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.: 002 EWA: Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved: 00 /00 /0000 :800
Reason Code: ERRORS OMISSIONS, Quantity Related A
Description: NO. pay Item for #2 Stone for Undistributed Quantities
Original Contract Amount 583,765.77
Current Change Order Amount 0.00 Percent: 0.000
Total Previous Approved Changes 0.00 Percent: 0.000
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)
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
Contract No:R -29657 Change Order No.: 002
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$2M-- GT$2M
(Days per Contract) (50 SS days 100 SS days 200 SS Days GT 200 SS days)
Verbal Approval Required? Y N If Y, by Date Issued
Total Change To- Date >5 Y N If Y Copy to Program Budget Manager
Scope /Design Recommendation Y N If Y, Referred to Project Manager(PM)
Required?
Date to PM Date Returned
Approval Authority Concurs with PM? Y N If Y, Concurrence by Date
If N,Resolution: Approved Disapproved
Resolved by Date
LPA Signatures Required? Y N If Y, Date to LPA Date Returned
FHWA Signatures Required? Y N If Y, Date to FHWA Date Returned
Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer Date
Comments:
Contract No:R -29657 INDIANA Date:04/27/2011
Change Order No:002 Department of Transportation Page: 3
Contract: R -29657
Project: 0600390 State:0600390
Change Order Nbr: 002
Change Order Description: NO. pay Item for #2 Stone for Undistributed Quantities
Reason Code: ERRORS OMISSIONS, Quantity Related
CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change
0085 0600390 0085 205 -09543 TON 44.650 100.000 C Amount:$ 4,465.00
item Description: NO 2 STONE
Supplemental Descriptionl: NO. 2 Stone for Construction Entrances
Supplemental Description2:
Total Value for Change Order 002 4,465.00
Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended.
Change Order Explanation for Speclflc Line Item
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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:
HtHH1111f.H11111111fM1H1f 1HtHHH H1H1 f1HHt H111 HH111 Htt1 HHYHHHHR H11t1H11f1H11111t11f11HH1ffIHHf
NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.
Contract No:R -29657 INDIANA Date:04 /27/2011
Change Order No:002 Department of Transportation Page: 4
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APPROVED FOR LOCAL PUBLIC AGENCY
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(SIGNATURE) (TITLE) (DATE)
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SUBMITTED FOR CONSIDERATION
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APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
Approval Level Name of Approver Date Status