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7206 - Change Order 2 Executed Docusign Transmittal Coversheet File Name Purchasing Contact Contract Expiration DocuSign Envelope ID: 2F73A39B-6E47-4A5E-85E5-84F5667B95A8 7206 - Hickory Creek Phase 1 - CO#2 N/A Cori Power Contractor:McMahonContracting 3019 Roy Orr Blvd Grand Pririe, Texas. 75050 George Trabazo Hickory Creek Phase I (East)CHANGE ORDER NO.2 7206 PO #:193827 N/A Date Prepared:03/03/2021 Contract BID Amount:1,443,761.02$ 5% Contigency Amount:72,188.05$ Prior Approved CAA's:19,153.64$ Available Contingency:53,034.41$ 51,793.63$ Contingency Remaining:1,240.78$ Item No.Spec. Section No.UOM BID QTY +/- QTY Unit Price Extended Price 7 NCTCOG SY 1,045 1,667 4.92$ 8,201.64$ 29 NCTCOG SY 6,230 170 3.40$ 578.00$ 30 NCTCOG TN 120 20 187.44$ 3,748.80$ 44 NCTCOG CY 900 510 21.14$ 10,781.40$ 45 NCTCOG Block Sod Placement SY 8,000 1,730 4.65$ 8,044.50$ 46 NCTCOG Topsoil (6" Thick)SY 8,000 1,370 3.26$ 4,466.20$ 28 NCTCOG SY 5,820 217 61.39$ 13,321.63$ $49,142.17 COR-005 Saw-Cutting EA 1 250.00$ 250.00$ COR-006 LD 2 450.00$ 900.00$ COR-007 EA 1 1,501.46$ 1,501.46$ $2,651.46 Item No.Spec. Section No.UOM BID QTY +/- QTY Unit Price Extended Price EA -$ -$ -$ $0.00 -$ -$ -$ -$ $0.00 Hickory Creek Phase I (East)$51,793.63 1,443,761.02$ $70,947.27 $1,514,708.29 4.914% Revised Contract Amount: Percent Changes: Reason for change: Increase of existing quantities for additional lime process services needed due to field conditons, removal of material on the southwest corner of FM-2499, repairs needed to complete the project, and additional quantities for strom water compliance. The addition of new items to restore land owner access. CONTINGENCY ALLOWANCE AUTHORIZED (CAA) CONTRACT CHANGES QUANTITY CHANGES TO EXISTING ITEMS TOTAL CAA QTY CHANGES: NEW ITEMS OF WORK TOTAL OTHER FUNDED NEW ITEMS: TOTAL CHANGE ORDER #1: Total CAA's & CO's: Remove Gravel Drive 12" Lime Treated (37lbs/SY) Hydrated Lime (for 12" Lime Treatment) Unclassified Excavation Description of work included in Contract: Complete the widening of Hickory Creek Road from two lanes to four lanes divided between Teasley and FM-2499. Project: IFB# CIP/ENG# This CAA Request: PROJECT SCOPE AND REASON FOR CHANGE Prior Approved Other Funded CO's: Current Contract Amount w CO's: This CO Other Funding Request: Current Completion: New Completion: 9/1/2021 New Contract Days: Dustin Draper, Project Manager CITY OF DENTON CHANGE ORDER FORM City of Denton - Capital Projects 901-A Texas Street Denton, TX 76209 Total Change Request:51,793.63$ 1,462,914.66$ -$ Days +/- by: Curlex (Erosion Control) Description of work 11" Conc Pvmt TOTAL CAA NEW ITEMS: Flexbase Appropriate Signatory lines will be added by Purchasing Original BID/Contract Amount: Contingency funds are used at City's descretion per contract spec language OTHER FUNDING NEW ITEMS OTHER FUNDED CONTRACT CHANGES (CO) QUANTITY CHANGES TO EXISTING ITEMS NEW ITEMS OF WORK TOTAL OTHER FUNDED QTY CHANGES: Description of work OTHER FUNDING QTY CHNGS DocuSign Envelope ID: 2F73A39B-6E47-4A5E-85E5-84F5667B95A8 Project Manager 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: 2F73A39B-6E47-4A5E-85E5-84F5667B95A8 Exhibit CIQ McMahon Contracting, L.P. 5/5/2021 Certificate Of Completion Envelope Id: 2F73A39B6E474A5E85E584F5667B95A8 Status: Completed Subject: ***Purchasing Approval*** 7206 Hickory Creek Phase 1- Change Order #2 Source Envelope: Document Pages: 3 Signatures: 5 Envelope Originator: Certificate Pages: 6 Initials: 1 Cori Power AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 901B Texas Street Denton, TX 76209 cori.power@cityofdenton.com IP Address: 198.49.140.104 Record Tracking Status: Original 4/27/2021 8:34:53 AM Holder: Cori Power cori.power@cityofdenton.com Location: DocuSign Signer Events Signature Timestamp Cori Power cori.power@cityofdenton.com Senior Buyer City of Denton Security Level: Email, Account Authentication (None) Completed Using IP Address: 198.49.140.104 Sent: 4/27/2021 8:57:23 AM Viewed: 4/27/2021 8:57:53 AM Signed: 4/27/2021 9:08:55 AM 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: 4/27/2021 9:08:57 AM Viewed: 4/27/2021 9:28:11 AM Signed: 4/27/2021 9:28:57 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Dusty Draper Dustin.Draper@cityofdenton.com Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 4/27/2021 9:28:59 AM Viewed: 5/4/2021 10:10:27 AM Signed: 5/4/2021 10:11:14 AM Electronic Record and Signature Disclosure: Accepted: 5/4/2021 10:10:27 AM ID: efea3348-da1a-488e-8271-fe431887984f George Trabazo GeorgeT@mcmahoncontracting.com Project Manager Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 71.78.122.98 Sent: 5/4/2021 10:11:17 AM Viewed: 5/4/2021 10:12:41 AM Signed: 5/5/2021 11:50:28 AM Electronic Record and Signature Disclosure: Accepted: 5/4/2021 10:12:41 AM ID: dcb3a2fd-0601-4aa2-86cc-c1ef3421157d Signer Events Signature Timestamp 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: 198.49.140.10 Sent: 5/5/2021 11:50:31 AM Viewed: 5/6/2021 9:01:13 AM Signed: 5/6/2021 9:01:26 AM Electronic Record and Signature Disclosure: Accepted: 5/6/2021 9:01:13 AM ID: 777a7f81-f7d4-480b-8cd2-5c9d2fb8cdb6 Cori Power cori.power@cityofdenton.com Senior Buyer City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.104 Sent: 5/6/2021 9:01:28 AM Viewed: 5/6/2021 9:33:15 AM Signed: 5/6/2021 9:33:33 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 Cheyenne Defee cheyenne.defee@cityofdenton.com Contract Administrator City of Denton Security Level: Email, Account Authentication (None) Sent: 5/6/2021 9:01:28 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: 5/6/2021 9:33:35 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Dusty Draper Dustin.Draper@cityofdenton.com Security Level: Email, Account Authentication (None) Sent: 5/6/2021 9:33:35 AM Electronic Record and Signature Disclosure: Accepted: 5/4/2021 10:10:27 AM ID: efea3348-da1a-488e-8271-fe431887984f Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 4/27/2021 8:57:23 AM Certified Delivered Security Checked 5/6/2021 9:33:15 AM Signing Complete Security Checked 5/6/2021 9:33:33 AM Completed Security Checked 5/6/2021 9:33:35 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of Denton (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: 7/21/2017 3:59:03 PM Parties agreed to: Dusty Draper, George Trabazo, Rebecca Diviney, Dusty Draper How to contact City of Denton: 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: purchasing@cityofdenton.com To advise City of Denton 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 melissa.kraft@cityofdenton.com and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address.. 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