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CHANGE ORDER - REQUISITION - 27851 EAST PROSPECT ROAD IMPROVEMENTS
Change Order Form Engineering Department PROJECT TITLE: E. Prospect Rd. Improvements PROJECT NUMBER: 30521700.6 (Bic #5958) CONTRACTOR: Don Kehn Construction, Inc. (PO #6601846) CHANGE ORDER NUMBER: 4 n preparing cnange oraers snow in oraer as separate numoerea paragrapns the tollowing 1. Reason for change. 2. Description of change. 3. Change in contract cost. 4. Change in contract time. 1&2. See attached sheet for detail. 3. The contract cost will increase by $38,888.23 4. There will be no change in contract time. ORIGINAL CONTRACT COST $3,757,538,35 TOTAL APPROVED CHANGE ORDERS $46,462.32 TOTAL PENDING CHANGE ORDERS $0.00 TOTAL THIS CHANGE ORDER $38,888.23 TOTAL % OF THIS CHANGE ORDER 1.03% TOTAL C.O. % OF ORIGINAL CONTRACT 2.27% ADJUSTED CONTRACT COST $3,842,888.90 (Assuming all change orders approved) ACCEPTED BY: Q ),-a W -- DATE: I (D - 19 - 0(0 (Contractor's Representative) / ACCEPTED BY: /� — ���� DATE: lect Man er), REVIEWED BY: yi,1 l0 - 23- OD& APPROVED BY: L k A DATE: (D a mend H APPROVED BY: DATE: (Purch sing Agent over $30,000) cc: Contractor Purchasing Project file Engineering Department • 281 North College Avenue • P.O. Box 580 - Fort Collins, CO 80522-0580 - (970) 221-6605 CHANGE ORDER NO.4 CO-001 FLOWFILL CY 0 $ $ 56.00 348 $ 19,488.00 348 $ 19,488.00 CO-002 15" CORREGATED STEEL PIPE LF 0 $ $ 47.15 90 $ 4,243.50 90 $ 4,243.50 CO-003 15" CORREGATED STEEL PIPE - FLARED END SECTION LF 0 $ $ 273.70 4 $ 1,094.80 4 $ 1,094.80 CO-004 15" REINFORCED CONCRETE PIPE LF 0 $ $ 43.70 30 $ 1.311.00 30 $ 1,311.00 CO-005 15" REINFORCED CONCRETE PIPE - BELL FLARED END SECTION EACH 0 $ $ 621.00 1 $ 621.00 1 $ 621.00 CO-006 AREA INLET DRAIN EACH 0 $ $ 3,450.00 1 $ 3,450.00 1 $ 3,450.00 CO-007 BEHNKE TREE - AUSTRIAN PINE EACH 0 $ $ 517.50 12 $ 6,210.00 12 $ 6,210.00 CO-008 BEHNKE TREE -PINION PINE EACH 0 $ $ 431.25 1 $ 431.25 1 $ 431.25 CO-009 BEHNKE TREE - RADIANT CRAB APPLE EACH 0 $ $ 402.50 3 $ 1,207.50 3 $ 1,207.50 CO-010 BEHNKE TREE - KENTUCKY COFFEE TREE EACH 0 $ $ 517.50 2 $ 1,035.00 2 $ 1,035.00 CO-011 SIDEWALK DRAIN INSTALLATION UNDER BRIDGE LS 0 $ $ 5,028.67 1 $ 5,028.67 1 $ 5,028.67 CO-012 RESTRAINT WALL ON AB LINE LS 0 $ $ 1,112.81 1 $ 1,112.81 1 $ 1,112.81 CO-013 BACKFILLING OF STORM SYSTEM F AT GASLINE LS 0 $ $ 333.50 1 $ 333.50 1 $ 333.50 CO-014 PAYMENT ADJUSTMENT- TYPE II BEDDING (CY) CY 350 $ 23.60 $ 23.60 67 $ 1,581.20 -283 $ 6,678.80 38,888.23