HomeMy WebLinkAboutCHANGE ORDER - RFP - ART IN PUBLIC PLACESCHANGE ORDER NO.
PROJECT TITLE: APP — Drake Water Reclamation
CONTRACTOR: Lynne Hull
PROJECT NUMBER:
PURCHASE ORDER NO.: 5503566
DESCRIPTION: East Drake Pondworks
1. Reason for change:
Change in payment schedule. Art elements within the payment schedule have been changed due to
delays in the construction schedule. See attachment.
2. Description of Change:
These items: Water Sluice and Picnic Area elements have been moved on the payment schedule from
10 B. to 10 C.
3. Change in Contract Cost: None
4. Change in Contract Time:
ORIGINAL CONTRACT COST $
TOTAL APPROVED CHANGE ORDERS
TOTAL PENDING CHANGE ORDERS
TOTAL THIS CHANGE ORDER
TOTAL % OF ORIGINAL CONTRACT, THIS C.O.: %
TOTAL % OF ORIGINAL CONTRACT, ALL C.O.'S: %
ADJUSTED CONTRACT COST $
(Assuming all change orders approved)
ACCEPTED BY:
ACCEPTED BY:
REVIEWED BY:
Title:
APPROVED BY:
Title:
APPROVED BY:
Purchasing Agent over $15,000
cc: Purchasing
DATE: kZALI Z Z40-e 5
DATE:
DATE:
DATE:
DATE:
City of Fort Collins
Administrative Services
Finance Department - Accounting Division
BLANKET EXEMPTION CERTIFICATE
(For use by States, Territories, or political subdivision thereof)
Date: November 7, 2005
The undersigned hereby certifies that she is Joyce Grenz, Accounts Payable
Representative of City of Fort Collins to execute this certificate and that the article or
articles specified in the accompanying orders, or on the reverse side hereof, are purchased
from WHITEWATER WEST INDUSTRIES LTD for the
exclusive use of the City of Fort Collins of the State of Colorado.
It is understood that the exemption from tax in the case of sales of articles under this
exemption certificate to a State; etc., is limited to the sale of articles purchased for its
exclusive use, and it is agreed that if articles purchased tax free under this exemption
certificate are used otherwise or are sold to employees or others, such fact will be
reported by me to the manufacturer of the article or articles covered by this certificate. It
is also understood that the fraudulent use of this certificate to secure exemption will
subject the undersigned and all guilty parties to a fine of not more than $10,000.00 or to
imprisonment for not more than five years, or both, together with costs of prosecution.
State of Colorado Department of Revenue, Certificate of Exemption
Identification Number 98-04502.
(Signature'
Accounts Payable Rep — Accounting Dept.
(Title of Officer)
215 North Mason Street • 2nd Floor • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6770 • FAX (970) 221-6782
P. 01
TRANSACTION REPORT
NOV-07-05
MON 03:07 PM
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A_d_ministrative Services
Finance Department - Accounting Division
BLANKET EXEMPTION CERTIFICATE
(For use by States, Territories, or political subdivision thereof)
Date: November 7, 2005
The undersigned hereby certifies that she is Jovice Grenz, Accounts .._Payable
Representative of City of Fort Collins to execute this certificate and that the article or
articles specified in the accompanying orders, or on the reverse side hereof, are purchased
from WfflTEWATER WEST INDUSTRIES LTD for the
exclusive use of the City of Fort Collins of the State of Colorado.
It is understood that the exemption from tax inthe case of sales of articles under this
exemption certificate to a State, etc., is limited to the sale of articles purchased for its
exclusive use, and it is- agreed that if articles purchased tax free under this exemption
certificate are used. otherwise or are sold to employees or others, such fact will be