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Home My WebLink AboutCORRESPONDENCE - BID - 8844 MISCELLANEOUS CONCRETE (27)Change Order Form (for Work Orders) Official Purchasing Form Last updated 10/2017 CHANGE ORDER NO. 1 PROJECT TITLE: Colorado St. Driveway Replacement CONTRACTOR: Lightfield Enterprises, Inc WORK ORDER NUMBER: 2020-06042020 PO NUMBER: 9200901 DESCRIPTION: 1. Reason for Change: Scope and Cost 2. Description of Change: Additional work was required due to field conditions. 20 cubic yards of Flowable Fill was required to void under old driveway area. 3. Change in Work Order Price: $2,087.08 4. Completion Date (if changed): NA ORIGINAL WORK ORDER PRICE $ 31,523.13 TOTAL APPROVED CHANGE ORDER $ 0.00 TOTAL PENDING CHANGE ORDER $ 0.00 TOTAL THIS CHANGE ORDER $ 2,087.08 TOTAL % OF THIS CHANGE ORDER 6.62% TOTAL C.O.% OF ORIGINAL WORK ORDER 6.62% ADJUSTED WORK ORDER COST $ 33,610.21 CONTRACTOR: Lightfield Enterprises, Inc By: Date: Name: Title: ACCEPTANCE: Date: Douglas Groves, Manager, Stormwater Maintenance Operations REVIEWED: Date: Dale Elliot, Senior Buyer REQUISITION ENTERED BY: Date: DocuSign Envelope ID: CAB29416-3AAE-4B57-AC24-D214B9027286 Melissa Walker June 23, 2020 Coordinator, Finance June 24, 2020 Chris Hansen General Manager June 24, 2020 June 24, 2020 Change Order Form (for Work Orders) Official Purchasing Form Last updated 10/2017 ACCEPTANCE: Date: Andrew Gingerich, Director, Water Field Operations ACCEPTANCE: Date: Matt Fater, Interim Deputy Director, Water Engineering & Field Services ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) DocuSign Envelope ID: CAB29416-3AAE-4B57-AC24-D214B9027286 June 26, 2020 June 24, 2020 5/22/2020 5/26/2020 6/26/2020 Project Notice to Proceed Project Construction Project Final Completion/Acceptance Schedule for Concrete Repairs for the Colorado St. Driveway Replacement DocuSign Envelope ID: CAB29416-3AAE-4B57-AC24-D214B9027286 Total 304.02 Aggregate Base Course/Recycled Concrete Base > 5 Tons Ton 50 $40.01 $2,000.50 608.22 Flatwork - 6" Square Foot 3,800 $6.11 $23,218.00 SUB TOTAL COST $25,218.50 25% CONTINGENCY for Traffic Control Devices, Flagging Hours, Dump Fees, Temp Patching, Base Material, Backfill, Top Soil. Actual costs will be invoiced at contractual unit prices. 25% $ 6,304.63 ESTIMATED TOTAL COST $31,523.13 Item No. Description COST ESTIMATE FOR Colorado driveway replacement Unit Quantity 2020 Revised Unit Price ADDITIONAL SERVICES Page 1 of 1 DocuSign Envelope ID: CAB29416-3AAE-4B57-AC24-D214B9027286 Certificate Of Completion Envelope Id: CAB294163AAE4B57AC24D214B9027286 Status: Completed Subject: Please DocuSign: Schedule.pdf, LEI - CO1 Colorado Driveway Replacement .docx, LEI Estimatel.pdf Source Envelope: Document Pages: 4 Signatures: 6 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: 24.8.181.157 Record Tracking Status: Original 6/18/2020 3:50:43 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: 6/18/2020 3:53:13 PM Viewed: 6/23/2020 2:16:41 PM Signed: 6/23/2020 2:17:00 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: Pre-selected Style Using IP Address: 98.245.155.189 Sent: 6/23/2020 2:17:02 PM Viewed: 6/24/2020 10:30:26 AM Signed: 6/24/2020 10:31:16 AM Electronic Record and Signature Disclosure: Accepted: 7/17/2017 10:10:53 AM ID: ec325db7-18a4-43ec-adda-55edfc66426b Chris Hansen chansen@lightfieldenterprises.com General Manager Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 173.164.55.1 Sent: 6/24/2020 10:31:18 AM Viewed: 6/24/2020 10:34:47 AM Signed: 6/24/2020 10:34:58 AM Electronic Record and Signature Disclosure: Accepted: 6/24/2020 10:34:47 AM ID: 10d5690e-4306-46e5-b8e9-727fc8794806 Signer Events Signature Timestamp Accepted: 9/23/2016 12:48:18 PM ID: 9c37cd68-2529-4278-9e6b-666790f7bcdb Andrew S. Gingerich AGingerich@fcgov.com Director, Water Field Operations City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 73.243.86.150 Sent: 6/24/2020 10:47:31 AM Resent: 6/26/2020 10:18:18 AM Viewed: 6/26/2020 10:20:58 AM Signed: 6/26/2020 10:21:07 AM Electronic Record and Signature Disclosure: Accepted: 9/23/2016 12:43:26 PM ID: 54958527-6090-40dd-bdca-d96cb40048ed Matt Fater MFATER@fcgov.com Special Projects Manager City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 67.174.120.150 Sent: 6/24/2020 10:47:32 AM Viewed: 6/24/2020 10:56:59 AM Signed: 6/24/2020 11:08:59 AM Electronic Record and Signature Disclosure: Accepted: 12/6/2016 4:18:20 PM ID: 1a8e8b4d-d117-4be0-975e-cb548f822347 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 6/26/2020 10:18:18 AM Certified Delivered Security Checked 6/26/2020 10:20:58 AM Signing Complete Security Checked 6/26/2020 10:21:07 AM Completed Security Checked 6/26/2020 10:21:07 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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Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. Electronic Record and Signature Disclosure created on: 8/25/2016 10:28:47 AM Parties agreed to: Melissa Walker, Elliot Dale, Chris Hansen, Douglas E Groves, Andrew S. 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Douglas E Groves DeGroves@fcgov.com WATER UTIL FIELD OPERATIONS SUPERINTENDENT City of Fort Collins - Utilities Water Utilities Engineering Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.59.47.100 Sent: 6/24/2020 10:31:18 AM Viewed: 6/24/2020 10:47:17 AM Signed: 6/24/2020 10:47:30 AM Electronic Record and Signature Disclosure: