6902 - Change Order 1 Executed
Docusign City Council Transmittal Coversheet
File Name
Purchasing Contact
City Council Target Date
Piggy Back Option
Contract Expiration
Ordinance
DocuSign Envelope ID: D81B8547-BB2B-4BEE-A41C-9A4710F6C333
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10. Contract
Changes
Contract Unit
Price
Revised Estimated
Cost
Remove
Concrete Curb
and Gutter
LF $7.00 $76,433.00
Remove
Concrete
Sidewalks and
Ramps
SF $1.10 $11,812.90
Remove
Concrete Drive
Approach
SF $1.60 $10,104.00
Remove
Concrete Valley
Gutter and Apron
SF $1.35 $8,486.10
Remove Asphalt
Pavement SY $3.95 $131,452.05
12" Lime
Subgrade
Treatment
SY $6.90 $216,832.50
Lime at 7% (70
lbs/SY)TN $189.25 $208,175.00
3" Type C
Surface Course
(PG 64-22)
SY $13.40 $429,349.40
6" Type B Base
Course (PG 64-
22)
EA $25.50 $555,390.00
6" Curb and 18"
Gutter LF $28.45 $344,387.25
4" Concrete
Sidewalk 20 LF $5.40 $57,990.60
5' Wide Type 1
Ramp (6' Long)23 2 EA $1,875.00 $11,250.00
Remove Existing
Sanitary Sewer
Manholes
EA $500.00 $4,500.00
17 31707 32041 $13.40 $424,873.80
15 31263 31425 $6.90 $215,714.70
16 1094 1100 $189.25 $207,039.50
10 4812 6315 $1.60 $7,699.20
14 31707 33279 $3.95 $125,242.65
7 5756 10919 $7.00 $40,292.00
8 5211 10739 $1.10 $5,732.10
Hinkle and Windsor Paving and
Drainage Improvements
CITY OF DENTON CHANGE ORDER
1. Division (Department)
Capital Projects
2. Purchase Order No.
188796
Original Estimated
Cost
6. Date Prepared
Wednesday, October 9, 2019
7. Name and Address of Contractor
Quality Excavation
5580 US Hwy 377 Aubrey, TX 76227
4. Name of Project
3. Change Order No.
1
5. Project Acct No.
350425469.40000
350425467.40000
8. Description of Work Included in Contract
Drainage and sewer improvements and paving reconstruction for Windsor Drive and Hinkle Drive
This change order is to extend the proposed sewer replacements in Hinkle Drive in order to remove some manholes from within the
Hinkle pavement. It also includes additonal quantities for the roundabout and the additional drainage needs.
12 5992 6286 $1.35 $8,089.20
9. Changes ordered and reason ordered
Bid Item No Original Estimated
Quantity
Revised
Estimate
Qtit
Negotiated
C.O. Unit Price
78 6
18 20208 21780 $25.50 $515,304.00
19 6156 12105 $28.45 $175,138.20
5911 10739 $5.40 $31,919.40
6 $1,875.00 $3,750.00
9 $500.00 $3,000.00
Page 1 of 3
DocuSign Envelope ID: D81B8547-BB2B-4BEE-A41C-9A4710F6C333
Remove Existing
Sanitary Sewer
Pipes
LF $5.50 $6,864.00
8" SDR-35 PVC
Sewer LF $69.00 $67,620.00
10" SDR-26 PVC
Sewer LF $155.00 $11,625.00
4' Dia Standard
SS Manhole EA $5,700.00 $45,600.00
Sanitary Sewer
Services EA $1,500.00 $19,500.00
Manhole Drop
Connection EA $0.00 $3,400.00
30" Class III RCP LF $0.00 $8,264.96
4'x4' Junction Box EA $0.00 $18,500.00
5 Sack Concrete CY $0.00 750 $86,250.00
6" Thick Colored-
Stamped
Concrete incl.
Flowable Fill
Base
SY $0.00 $62,391.20
$2,396,177.96
$518,744.21
New contract time: 417 days12. Contract time increased/decreased by:17 day(s)
79 1188 1248 $5.50 $6,534.00
81 940 980 $69.00 $64,860.00
-0 2$1,700.00 $0.00
-0 16$516.56 $0.00
$186.80 $0.00
-0 1$18,500.00 $0.00
- 0 334
$115.00 $0.00
TOTAL $1,877,433.75
11. Current Contract Price
$6,746,003.21 Decrease in contract price
THE AFOREMENTIONED CHANGE, AND WORK AFFECTED THEREBY, IS SUBJECT TO ALL CONTRACT STIPULATIONS AND COVENANTS.
14. ACCEPTED BY CITY ENGINEER/DIRECTOR OF CAPITAL
PROJECTS:
________________________
Signature
_________
Date
13. SUBMITTED BY:_______________________
Project Manager
_________
Date
15. ACCEPTED BY CONTRACTOR: ________________
Title
________________________
Signature
_________
Date
16. CITY MANAGER:________________________
Signature
_________
Date
ATTEST: CITY SECRETARY ________________________
Signature
_________
Date
$6,227,259.00 Increase in contract price
New Contract Price
83 19 75 $155.00 $2,945.00
87 11 13 $1,500.00 $16,500.00
86 4 8 $5,700.00 $22,800.00
Page 2 of 3
DocuSign Envelope ID: D81B8547-BB2B-4BEE-A41C-9A4710F6C333
18. APPROVED AS TO LEGAL FORM:________________________
Signature
_________
Date
17. PURCHASING/FINANCE:________________________
Signature
_________
Date
Page 3 of 3
DocuSign Envelope ID: D81B8547-BB2B-4BEE-A41C-9A4710F6C333
Exhibit
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as
defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after
the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
misdemeanor.
1 Name of vendor who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business
day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship
as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer
named in this section AND the taxable income is not received from the local governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an
officer or director, or holds an ownership of one percent or more?
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
DocuSign Envelope ID: D81B8547-BB2B-4BEE-A41C-9A4710F6C333
Certificate Of Completion
Envelope Id: D81B8547BB2B4BEEA41C9A4710F6C333 Status: Completed
Subject: Please DocuSign: City Council Contract 6902 Change Order #1 - Hinkle and Windsor Construction
Source Envelope:
Document Pages: 5 Signatures: 8 Envelope Originator:
Certificate Pages: 7 Initials: 1 Laura Hermosillo
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
laura.hermosillo@cityofdenton.com
IP Address: 129.120.6.150
Record Tracking
Status: Original
1/7/2020 6:03:20 PM
Holder: Laura Hermosillo
laura.hermosillo@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Laura Hermosillo
laura.hermosillo@cityofdenton.com
Senior Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 129.120.6.150
Sent: 1/7/2020 6:22:40 PM
Viewed: 1/7/2020 6:22:50 PM
Signed: 1/7/2020 6:23:35 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Lori Hewell
lori.hewell@cityofdenton.com
Purchasing Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 1/7/2020 6:23:39 PM
Viewed: 1/8/2020 1:46:46 PM
Signed: 1/8/2020 2:08:02 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Mack Reinwand
mack.reinwand@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 1/8/2020 2:08:06 PM
Viewed: 1/10/2020 11:36:44 AM
Signed: 1/10/2020 11:40:10 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Garland Wilson
garland@qualityexcavationltd.com
Vice President
Quality Excavation, Ltd.
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 173.219.29.103
Sent: 1/10/2020 11:40:13 AM
Viewed: 1/10/2020 2:03:30 PM
Signed: 1/10/2020 2:09:25 PM
Electronic Record and Signature Disclosure:
Accepted: 10/6/2017 11:03:26 AM
ID: 686fb2c9-818b-4c5d-90e2-8c7008b347bf
Signer Events Signature Timestamp
Todd Estes
Todd.Estes@cityofdenton.com
City Engineer
Capital Projects
Security Level: Email, Account Authentication
(None)
Signature Adoption: Drawn on Device
Using IP Address: 174.246.97.70
Signed using mobile
Sent: 1/10/2020 2:09:29 PM
Viewed: 1/10/2020 4:36:24 PM
Signed: 1/10/2020 4:36:40 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kyle Pedigo
kyle.pedigo@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 1/10/2020 2:09:29 PM
Viewed: 1/10/2020 2:10:50 PM
Signed: 1/10/2020 2:11:53 PM
Electronic Record and Signature Disclosure:
Accepted: 1/10/2020 2:10:50 PM
ID: 93e68ac8-d94a-4434-a14b-259e14c07f73
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 129.120.6.150
Sent: 1/10/2020 4:36:44 PM
Viewed: 2/12/2020 12:42:35 PM
Signed: 2/12/2020 12:43:09 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Todd Hileman
Todd.Hileman@cityofdenton.com
City Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 47.190.47.120
Signed using mobile
Sent: 2/12/2020 12:43:13 PM
Viewed: 2/12/2020 12:43:51 PM
Signed: 2/12/2020 12:43:55 PM
Electronic Record and Signature Disclosure:
Accepted: 7/25/2017 11:02:14 AM
ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21
Rosa Rios
rosa.rios@cityofdenton.com
City Secretary
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 2/12/2020 12:43:57 PM
Viewed: 2/12/2020 12:44:45 PM
Signed: 2/12/2020 12:45:23 PM
Electronic Record and Signature Disclosure:
Accepted: 2/12/2020 12:44:45 PM
ID: 661a35a2-5b85-4cdc-817a-1178084ba065
In Ierson Signer Events Signature Timestamp
Editor DeliverI Events Status Timestamp
Igent DeliverI Events Status Timestamp
IntermediarI DeliverI Events Status Timestamp
Certified DeliverI Events Status Timestamp
CarIon CopI Events Status Timestamp
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 1/7/2020 6:23:39 PM
Viewed: 2/12/2020 12:46:13 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Sherri Thurman
sherri.thurman@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 1/10/2020 4:36:44 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jane Richardson
jane.richardson@cityofdenton.com
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 2/12/2020 12:43:11 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Zolina Parker
zolina.parker@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Sent: 2/12/2020 12:43:12 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jane Richardson
jane.richardson@cityofdenton.com
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 2/12/2020 12:43:13 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Zolaina Parker
Zolaina.Parker@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 2/12/2020 12:43:13 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Annie Bunger
Annie.Bunger@cityofdenton.com
Contract Control Specialist
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 2/12/2020 12:45:25 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Iitness Events Signature Timestamp
IotarI Events Signature Timestamp
Envelope SummarI Events Status Timestamps
Envelope Sent Hashed/Encrypted 2/12/2020 12:45:25 PM
Certified Delivered Security Checked 2/12/2020 12:45:25 PM
Signing Complete Security Checked 2/12/2020 12:45:25 PM
Completed Security Checked 2/12/2020 12:45:25 PM
IaIment Events Status Timestamps
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