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Home My WebLink AboutCORRESPONDENCE - RFP - 8475 CIVIL ENGINEERING PROFESSIONAL ON-CALL (44)Change Order Form (for Work Orders) Official Purchasing Form Last updated 10/2017 CHANGE ORDER NO. 1 PROJECT TITLE: Halligan Project - Easement Creation-Calloway Hill Preserve/Landowners Association CONTRACTOR: Interwest Consulting Group WORK ORDER NUMBER: ICG-HWSP-2019-1 PO NUMBER: 9191777 DESCRIPTION: 1. Reason for Change: Scope 2. Description of Change: Additional scope has been expanded from the original easement creation to include the Carpenter Property. Details are attached in the estimate. 3. Change in Work Order Price: $ 3,525.00 4. Completion Date (if changed): NA ORIGINAL WORK ORDER PRICE $ 17,000.00 TOTAL APPROVED CHANGE ORDER 00.00 TOTAL PENDING CHANGE ORDER 00.00 TOTAL THIS CHANGE ORDER $ 3,525.00 TOTAL % OF THIS CHANGE ORDER 20.7% TOTAL C.O.% OF ORIGINAL WORK ORDER 20.7% ADJUSTED WORK ORDER COST $ 20,525.00 CONTRACTOR: Interwest Consulting Group By: Date: Name: Title: ACCEPTANCE: Date: Tawnya Ernst, Sr Specialist, Real Estate REQUISITION ENTERED: Date: REVIEWED: Date: Elliot Dale, Senior Buyer DocuSign Envelope ID: 2789665A-63E0-4E84-8BB2-2A8E39FAFF62 Coordinator, Finance 10/28/19 Melissa Walker October 30, 2019 November 1, 2019 Mike Oberlander Project Manager October 30, 2019 Change Order Form (for Work Orders) Official Purchasing Form Last updated 10/2017 APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Eileen Dornfest, Civil Engineer III ACCEPTANCE: Date: Carol Webb, Deputy Director – Water Resources & Treatment Operations ACCEPTANCE: Date: Theresa Connor, Deputy Director – Water Engineering & Field Services ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) DocuSign Envelope ID: 2789665A-63E0-4E84-8BB2-2A8E39FAFF62 November 3, 2019 November 4, 2019 November 3, 2019 DocuSign Envelope ID: 2789665A-63E0-4E84-8BB2-2A8E39FAFF62 DocuSign Envelope ID: 2789665A-63E0-4E84-8BB2-2A8E39FAFF62 Certificate Of Completion Envelope Id: 2789665A63E04E848BB22A8E39FAFF62 Status: Completed Subject: Please DocuSign: Interwest Consulting Group - CO1 - Easement Creation - Calloway Hill Preservat... Source Envelope: Document Pages: 4 Signatures: 7 Envelope Originator: Certificate Pages: 5 Initials: 0 Angel Anderson AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) 215 N Mason Street Fort Collins, CO 80522 aanderson@fcgov.com IP Address: 198.59.47.100 Record Tracking Status: Original 10/22/2019 1:02:54 PM Holder: Angel Anderson aanderson@fcgov.com Location: DocuSign Signer Events Signature Timestamp Melissa Walker mjwalker@fcgov.com Coordinator, Finance City of Fort Collins – Utilities Financial Operations Security Level: Email, Account Authentication (None) Signature Adoption: Drawn on Device Using IP Address: 198.59.47.100 Sent: 10/22/2019 1:05:54 PM Resent: 10/28/2019 12:19:48 PM Viewed: 10/28/2019 8:06:15 AM Signed: 10/28/2019 12:57:10 PM Electronic Record and Signature Disclosure: Accepted: 12/20/2016 10:08:43 AM ID: d9d08390-1c30-4e0f-8970-cda5245e1382 Elliot Dale edale@fcgov.com Buyer City of Fort Collins Security Level: Email, Account Authentication (None) Signature Adoption: Uploaded Signature Image Using IP Address: 198.59.47.100 Sent: 10/28/2019 12:57:12 PM Resent: 10/30/2019 1:51:42 PM Viewed: 10/28/2019 1:05:47 PM Signed: 10/30/2019 3:56:18 PM Electronic Record and Signature Disclosure: Accepted: 7/17/2017 10:10:53 AM ID: ec325db7-18a4-43ec-adda-55edfc66426b Mike Oberlander moberlander@interwestgrp.com Project Manager Interwest Consulting Group Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 23.31.75.209 Sent: 10/30/2019 3:56:19 PM Resent: 10/31/2019 8:37:48 AM Signer Events Signature Timestamp Eileen Dornfest edornfest@fcgov.com Special Projects Manager City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 174.209.10.151 Sent: 11/1/2019 12:45:15 PM Viewed: 11/3/2019 5:33:22 AM Signed: 11/3/2019 5:33:55 AM Electronic Record and Signature Disclosure: Accepted: 9/29/2017 7:50:54 AM ID: 2cb66c3f-651b-43ec-8309-8d841ea15c6c Carol Webb cwebb@fcgov.com Water Resource/Treatment Operations Manager City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Uploaded Signature Image Using IP Address: 198.59.47.100 Sent: 11/3/2019 5:33:57 AM Viewed: 11/4/2019 11:17:54 AM Signed: 11/4/2019 11:17:58 AM Electronic Record and Signature Disclosure: Accepted: 8/30/2017 3:00:50 PM ID: 64e1e037-73d2-4b27-a924-9f00549c1bdc Theresa Connor tconnor@fcgov.com Water Engineering & Field Services Operations Manager City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 24.9.116.148 Sent: 11/3/2019 5:33:57 AM Viewed: 11/3/2019 5:59:02 AM Signed: 11/3/2019 5:59:18 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 11/3/2019 5:33:57 AM Certified Delivered Security Checked 11/4/2019 11:17:54 AM Signing Complete Security Checked 11/4/2019 11:17:58 AM Completed Security Checked 11/4/2019 11:17:58 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of Fort Collins - Utilities Water Engineering Field Operations (we, us or Company) may be required by law to provide to you certain written notices or disclosures. 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Electronic Record and Signature Disclosure created on: 8/25/2016 10:28:47 AM Parties agreed to: Melissa Walker, Elliot Dale, Mike Oberlander, Tawnya Ernst, Eileen Dornfest, Carol Webb How to contact City of Fort Collins - Utilities Water Engineering Field Operations: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: aanderson@fcgov.com To advise City of Fort Collins - Utilities Water Engineering Field Operations of your new e-mail address To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to us at aanderson@fcgov.com and in the body of such request you must state: your previous e-mail address, your new e-mail address. 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Viewed: 11/1/2019 12:45:09 PM Signed: 11/1/2019 12:45:13 PM Electronic Record and Signature Disclosure: Accepted: 10/10/2019 5:13:04 AM ID: 5b742880-60b5-49c6-9333-fc7d7ab4dc41 Tawnya Ernst ternst@fcgov.com Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.59.47.100 Sent: 10/30/2019 3:56:19 PM Viewed: 10/30/2019 4:06:21 PM Signed: 10/30/2019 4:06:29 PM Electronic Record and Signature Disclosure: Accepted: 5/13/2019 7:05:50 AM ID: 503e294e-4f91-43c9-8dcd-086adda80f45