HomeMy WebLinkAboutCHANGE ORDER - REQUISITION - 27536SEP-15-2006 FRI 01:23 PM CFO ENG, FAX NO. 9702216378 P. 01
Change Order Form
Eaglneerlag Department
PROJECT TITLE: 2005 Street Maintenance Program
PROJECT NUMBER: 320200 (Bid #6839)
CONTRACTOR:, Lafarge Northern, Inc. (PO #6602526)
CHANGE ORDER NUMBER: 3
n preparing change orders snow In or er as eepara a numberednuffibGred paragraphs the following:
1. Reason forchange. 2. Description of change-
3. Change in contract =t. 4. Change in contract time.
1 &2. See attached sheet for detail.
3. The contract cost will increase by $ 343.39
4. There will be no change in contract time.
ORIGINAL CONTRACT COST
TOTAL APPROVED CHANGE ORDERS
TOTAL PENDING CHANGE ORDERS
TOTAL THIS CHANGE ORDER
TOTAL % OF THIS CHANGE ORDER
TOTAL C.O. % OF ORIGINAL CONTRACT
ADJUSTED CONTRACT COST
(Assuming all change orders approved)
ACCEPTED BY:
APPROVED BYL
APPROVED BY:
e
r's Re
roject nginel
Project Manag,
APPROVED BY:,tid.Lr
Department Head
APPROVED BY:
oa Purch:tsing
convaclor
Pmjftt File
(Purchasing Agent over $30,000)
$343 3D Pcde�traln Acccscs ✓
0.01 %
1.73%
$2,8%339.30
$46,273.44
$0.00
$343-39
$2,B5B,958.13
DATE: J--?— /l04 -
DATE: —
DATE:
DATE: l0 �L�+•�__
DATE:
Enelneerina Department' 28l Nortlt College Avenue, P,O• no% 580 • Fart Collins, CO 80522-OSSO - (970) 221-6605
SEP-15-2006 FRI 01:23 PM CFO ENG,
FAX NO. 9702216378
P. 02
Change Order No.: 3
Dale; srrrr2oas
01y of Pori CoWns 2006 Asphalt Overlay FM)errl
Lafarge North America - Bid No. 5839
1 Reason For Change:
a. Patching fa 2005 Pade5tdan Access work is added to this contract
2 Description of Change:
a. Pay lump sum for asphalt patching
3 Change In Contract Amount
Total Pod
a. 800 Parkview
Unit
Guantily
Unit Price
Acceseas
403.50
Patching
TON
3.50
$
83.35
$
291.73
614.01
"NO PARKING" Sign with Stand
DAYIEA
1,0
$
1.52
S
1,52
614.07
Size ASign wilhStand
DAYIEA
2.0
S
1.22
S
2.44
614.11
Cone vAlh Reflective Strip
DAYIEA
5.0
$
0.60
$
3.00
014.17
TrafPo Control Supervisor
HR
1.5
$
29.80
$�
44.70
$
343.30
TOTAL CHANGE IN CONTRACTAMOUNT
$
343.39
4 Change In Contract Tama
a. No 8me will he added or charged for this work
TOTAL CHANGE IN CONTRACT TIME a nays
Page 1 of