7237 - Change Order 2 Executed
Docusign City Council Transmittal Coversheet
File Name
Purchasing Contact
City Council Target Date
Piggy Back Option
Contract Expiration
Ordinance
DocuSign Envelope ID: FC8687F9-6AEE-4439-BA5A-620B9A89D9F3
7237
Laura Hermosillo
2019 Street Reconstruction - CO#2
IFB
Not Applicable
December 17, 2020
N/A
20-2436
10. Contract Changes Contract Unit
Price
Revised Estimated
Cost
Added 8" & 10" Sewer Lining $0.00 $128,186.64
Mill & Overlay side street
connections $0.00 $81,378.00
Temporary Asphalt Repair -
School Reopenings $0.00 $2,498.10
Stuart Rd - Sanitary Sewer
Realignment $0.00 $4,575.00
Remove Asphalt payment $5.00 $279,955.00
12" Flex base $28.00 $92,904.00
3" Type C Surface $18.00 $1,305,720.00
6" Type B Base $30.00 $2,176,200.00
4" Waterline Bore Extension $0.00 $3,660.00
Remove Asphalt payment $6.00 $99,594.00
12" Lime Subgrade Treatment $8.00 $128,112.00
11 8,636 16,599 $6.00 $51,816.00
12 7517.00 16,014 $8.00 $60,136.00
FILE #7237
CITY OF DENTON CHANGE ORDER
1. Division (Department)
Engineering
2. Purchase Order No.
192874
Original Estimated
Cost
6. Date Prepared
9/5/2020
7. Name and Address of Contractor
Quality Excavation
5580 Highway 377. Aubrey, Tx. 76227
4. Name of Project
3. Change Order No.
2
5. Project Acct No.
350496402; 350498467; 640426541
9. Changes ordered and reason ordered
2019 Street Reconstruction Project
8. Description of Work Included in Contract
Work includes reconstruction of four Roadways. Also includes water and wastewater improvements
Negotiated
C.O. Unit Price
$0.00
New 0 1 $2,498.10
0 600 $135.63
Changes include extra work associated with unforseen conditions found in the field, utility conflicts, contract bid quantity underruns, and unsuitable subgrade found
on Thomas Street.
Bid Item No Original Estimated
Quantity
Revised
Estimate
Quantity
$0.00
New 0
New
1 $128,186.64 $0.00
new
55,706 55,991 $5.00 $278,530.00
0 1 $4,575.00 $0.00
12
$1,156,626.00 18 64,257
3,318 $28.00 $84,924.00
$30.00 $1,927,710.00
17 3,033
$0.00 New
19 64,257 72,540
72,540 $18.00
0 1 $3,660.00
Page 1 of 2
DocuSign Envelope ID: FC8687F9-6AEE-4439-BA5A-620B9A89D9F3
Lime @ 9% (81 lbs/sy)$178.00 $115,522.00
12" Flexible Base $23.00 $13,455.00
6" Curb and 18" Gutter $26.00 $57,824.00
Double Application Lime on
Windsor due to high sulfates $0.00 $7,047.00
Additional Water services at
Wilson Elementary $0.00 $11,995.00
Added 16" Sewer Lining $0.00 $256,913.80
spoils $15.00 $43,245.00
$4,808,784.54
$1,104,792.54
$7,047.00 $0.00
New 0 1 $11,995.00 $0.00
New 0 1 $256,913.80 $0.00
11. Original Contract Price + Previous CO's
$11,388,235.44 Decrease in contract price
13 304 649 $178.00 $54,112.00
16 516 585 $23.00 $11,868.00
19 2,145 2,224 $26.00 $55,770.00
New 0 1
26 1,500 2,883 $15.00 $22,500.00
TOTAL $3,703,992.00
12. Contract time increased/decreased by 67 days. New contract time 823 days.
14. ACCEPTED BY CITY ENGINEER/DIRECTOR OF CAPITAL PROJECTS
13. SUBMITTED BY:
THE AFOREMENTIONED CHANGE, AND WORK AFFECTED THEREBY, IS SUBJECT TO ALL CONTRACT STIPULATIONS AND COVENANTS.
18. APPROVED AS TO LEGAL FORM:
$10,283,442.90 Increase in contract price
New Contract Price
16. CITY MANAGER:
17. PURCHASING/FINANCE:
15. ACCEPTED BY CONTRACTOR: ________________
Title
ATTEST: CITY SECRETARY
Project Manager
Signature
Signature
Signature
Signature
Signature
Signature
Page 2 of 2
DocuSign Envelope ID: FC8687F9-6AEE-4439-BA5A-620B9A89D9F3
Vice President
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: FC8687F9-6AEE-4439-BA5A-620B9A89D9F3
Quality Excavation, LLC
1
X
None
none
X
X
10/27/2020
Certificate Of Completion
Envelope Id: FC8687F96AEE4439BA5A620B9A89D9F3 Status: Completed
Subject: Please DocuSign: City Council Contract 7237 - 2019 Street Reconstruction - CO#2
Source Envelope:
Document Pages: 4 Signatures: 8 Envelope Originator:
Certificate Pages: 6 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: 198.49.140.104
Record Tracking
Status: Original
10/20/2020 2:41:17 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: 198.49.140.104
Sent: 10/20/2020 2:47:38 PM
Viewed: 10/20/2020 2:47:48 PM
Signed: 10/20/2020 2:47:50 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: 198.49.140.104
Sent: 10/20/2020 2:47:52 PM
Viewed: 10/21/2020 7:48:11 AM
Signed: 10/21/2020 7:48:26 AM
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: 198.49.140.104
Sent: 10/21/2020 7:48:28 AM
Viewed: 10/26/2020 12:11:30 PM
Signed: 10/26/2020 12:12:24 PM
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: 173.219.29.14
Sent: 10/26/2020 12:12:26 PM
Viewed: 10/27/2020 6:00:37 AM
Signed: 10/27/2020 6:03:59 AM
Electronic Record and Signature Disclosure:
Accepted: 10/6/2017 11:03:26 AM
ID: 686fb2c9-818b-4c5d-90e2-8c7008b347bf
Signer Events Signature Timestamp
Trevor Crain
Trevor.Crain@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.104
Sent: 10/27/2020 6:04:01 AM
Viewed: 10/27/2020 8:05:41 AM
Signed: 10/27/2020 8:06:12 AM
Electronic Record and Signature Disclosure:
Accepted: 10/27/2020 8:05:41 AM
ID: ac48dfe5-f533-4f79-ac86-93a785939d5a
Rebecca Diviney
Rebecca.Diviney@cityofdenton.com
Director of Capital Projects/City Engineer
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 47.222.28.222
Signed using mobile
Sent: 10/27/2020 6:04:01 AM
Viewed: 10/27/2020 6:51:59 AM
Signed: 10/27/2020 6:52:24 AM
Electronic Record and Signature Disclosure:
Accepted: 10/27/2020 6:51:59 AM
ID: 2da29a6c-80cd-4e4d-99a5-ccf32829e029
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 198.49.140.104
Sent: 10/27/2020 8:06:14 AM
Viewed: 12/18/2020 8:12:56 AM
Signed: 12/18/2020 8:13:02 AM
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: 198.49.140.10
Sent: 12/18/2020 8:13:05 AM
Viewed: 12/18/2020 10:08:09 AM
Signed: 12/18/2020 10:08:13 AM
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: 198.49.140.104
Sent: 12/18/2020 10:08:15 AM
Viewed: 12/21/2020 11:36:25 AM
Signed: 12/21/2020 11:37:04 AM
Electronic Record and Signature Disclosure:
Accepted: 12/21/2020 11:36:25 AM
ID: 92e8aa19-9a73-4661-84b2-3674fd8ea569
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
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 10/20/2020 2:47:52 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: 10/27/2020 8:06:14 AM
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: 12/21/2020 11:37:06 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Tracy Holt
Tracy.Holt@cityofdenton.com
Administrative Assistant
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 12/21/2020 11:37:07 AM
Viewed: 12/21/2020 11:38:23 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 10/20/2020 2:47:38 PM
Certified Delivered Security Checked 12/21/2020 11:36:25 AM
Signing Complete Security Checked 12/21/2020 11:37:04 AM
Completed Security Checked 12/21/2020 11:37:07 AM
Payment Events Status Timestamps
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Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM
Parties agreed to: Garland Wilson, Trevor Crain, Rebecca Diviney, Todd Hileman, Rosa Rios
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