8143 - Change Order 1 Executed
Docusign Transmittal Coversheet
File Name
Purchasing Contact
Contract Expiration
DocuSign Envelope ID: C498F452-FE93-450D-9A2E-2F2170F47C49
CSP 8143
SWBPS 2MG GROUND STORAGE TANK RECOAT-CHANGE ORDER #1
Crystal Westbrook
N/A
Contractor:J. R. Stelzer
5850 Russell Drive, Suite 1
Lincoln, Nebraska 68507
James R. Stelzer
SWBPS 2MG Ground Storage Tank Recoat CHANGE ORDER NO.1
CSP8143 CIP/ENG#PO #:202972
Contract BID Amount:529,875.00$
5% Contingency Amount:26,494.00$
556,369.00$
Prior Approved CAA's:-$
Available Contingency:26,494.00$
$2,250.00 0
Contingency Remaining:24,244.00$ 100
Item
No.Spec. Section No.UOM BID QTY +/- QTY Unit Price Extended Price
$0.00
1 2,200.00$ 2,250.00$
$2,250.00
Item
No.Spec. Section No.UOM BID QTY +/- QTY Unit Price Extended Price
$0.00
-$ -$
$0.00
$2,250.00 TOTAL CO AMOUNT:
TOTAL OTHER FUNDED NEW ITEMS:
Contingency funds are used at City's discretion per contract spec language TOTAL CAA NEW ITEMS:
OTHER FUNDED CONTRACT CHANGES (CO)
QUANTITY CHANGES TO EXISTING ITEMS
Description of work
N/A
TOTAL OTHER FUNDED QTY CHANGES:
NEW ITEMS OF WORK
N/A
Exterior Ladder gate
Reason for change:
Contingency funds being utilized for the installation of an exterior ladder lock for the storage tank. This prevents unauthorized use of ladder,
protecting the public health.
CONTINGENCY ALLOWANCE AUTHORIZED (CAA) CONTRACT CHANGES
QUANTITY CHANGES TO EXISTING ITEMS
Description of work
TOTAL CAA QTY CHANGES:
NEW ITEMS OF WORK
Approved CO Days:0 New Contract Days:
PROJECT SCOPE AND REASON FOR CHANGE
Project Scope included in
Contract:Not included in contract
This CAA Request:Orig Contract Days:100 This CO Days Request:
4/19/2023 6/15/2023 7/7/2023
Prior Approved Other Funded CO's:-$
Current Contract Amount w CAA & CO's:529,875.00$
Total NTE Amount : This CO Other Funding Request:-$
Total Change Request:2,250.00$
New Completion Date:
CITY OF DENTON CHANGE ORDER FORM
City of Denton - Water Utilities
901A Texas Street
Denton, TX 76209
David Brown, Project Manager
Project:
IFB#N/A
Notice To Proceed Issued:Current Completion Date:
DocuSign Envelope ID: BB8F4B95-6416-455C-B183-32906FE843C3DocuSign Envelope ID: C498F452-FE93-450D-9A2E-2F2170F47C49
529,875.00$
556,369.00$
SWBPS 2MG Ground Storage Tank Recoat 2,250.00$
-$
532,125.00$
8.49%
0.42%
0%
Signatory Lines will be updated by Purchasing if required
SUBMITTED BY:_______________________________
ACCEPTED BY DIRECTOR _______________________________
ACCEPTED BY CONTRACTOR:_______________________________
ACCEPTED BY CONSULTANT/ENGINEER:_______________________________
PURCHASING:_______________________________
Name, Title
Name, Title
Name, Title
Name, Title
Name, Title
Signature
Signature
Signature
Signature
Signature
IS SUBJECT TO ALL CONTRACT STIPULATIONS AND COVENANTS.
Original BID/Contract Amount:
Original Total Not To Exceed Amount:
Total CAA's:
Total CO's:
Revised Contract Amount:
% of CAA Approved To-Date:
Total Change Order over Original Bid:
Percent Changes over NTE:
THE AFOREMENTIONED CHANGE, AND WORK AFFECTED THEREBY,
]
DocuSign Envelope ID: BB8F4B95-6416-455C-B183-32906FE843C3DocuSign Envelope ID: C498F452-FE93-450D-9A2E-2F2170F47C49
Mike Stelzer President
PMDAVID BROWN
Zack Dawson PE
Director,Stephen D. Gay
Senior BuyerCrystal Westbrook
Updated 5/18/2022
Description:
Change Order one is to install a lockable ladder gate on the ladder that leads to the top of the
tank. Staff recommends to install this for a second line of safety in preventing unauthorized
access to the ground storage tank.
Description of prior Amendment(s)/Change Order(s):
None
Approved by: ___________________________________________ Date: _______________
Director of Water Utilities or Designee
Water Utilities
Amendment &
Change Order Form
Please fill out all that is applicable to your request and give a
detailed description
Vendor: Stelzer PO#: 202972
Requested Date: 6/29/2023 Original Amount: $ 529,875.00
Requested by: David Brown Amount Spent to date: $ 479,875.00
Needs PUB Approval (Y/N): N Requested Amount: $ 2,250
Account Number (s): 630088517.1360.21100 New Total: $ 532,125.00
File/Contract #: 8143 Needs CC Approval (Y/N): N
DocuSign Envelope ID: BB8F4B95-6416-455C-B183-32906FE843C3
6/29/2023
DocuSign Envelope ID: C498F452-FE93-450D-9A2E-2F2170F47C49 SCOPE OF WORK
Certificate Of Completion
Envelope Id: C498F452FE93450D9A2E2F2170F47C49 Status: Completed
Subject: ***Purchasing Approval*** 8143-Change Order #1
Source Envelope:
Document Pages: 4 Signatures: 5 Envelope Originator:
Certificate Pages: 6 Initials: 0 Crystal Westbrook
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
crystal.westbrook@cityofdenton.com
IP Address: 198.49.140.104
Record Tracking
Status: Original
7/6/2023 9:56:17 AM
Holder: Crystal Westbrook
crystal.westbrook@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Crystal Westbrook
crystal.westbrook@cityofdenton.com
Senior Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 198.49.140.104
Sent: 7/6/2023 10:06:30 AM
Viewed: 7/6/2023 10:07:44 AM
Signed: 7/6/2023 10:08:33 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Mike Stelzer
mike@jrstelzer.com
President
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 104.218.67.126
Sent: 7/6/2023 10:08:34 AM
Viewed: 7/6/2023 11:56:46 AM
Signed: 7/6/2023 11:57:36 AM
Electronic Record and Signature Disclosure:
Accepted: 7/6/2023 11:56:46 AM
ID: 547e86b1-ee49-443c-baf0-595f75b28b52
DAVID BROWN
david.brown@cityofdenton.com
PM
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 7/6/2023 11:57:37 AM
Viewed: 7/7/2023 10:12:11 AM
Signed: 7/7/2023 10:12:36 AM
Electronic Record and Signature Disclosure:
Accepted: 4/10/2019 2:54:36 PM
ID: 20238ddf-ccd6-4d52-988f-8c9f3436055e
Zack Dawson
zdawson@parkhill.com
PE
Security Level: Email, Account Authentication
(None), Login with SSO Signature Adoption: Pre-selected Style
Using IP Address: 138.199.118.214
Sent: 7/7/2023 10:12:38 AM
Viewed: 7/7/2023 10:30:32 AM
Signed: 7/7/2023 10:32:02 AM
Electronic Record and Signature Disclosure:
Accepted: 7/7/2023 10:30:32 AM
ID: 089f9fef-6367-4a37-89fc-b4da16d34177
Signer Events Signature Timestamp
Stephen D. Gay
stephen.gay@cityofdenton.com
Director,
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 7/7/2023 10:32:05 AM
Viewed: 7/7/2023 1:15:05 PM
Signed: 7/7/2023 1:16:47 PM
Electronic Record and Signature Disclosure:
Accepted: 7/7/2023 1:15:05 PM
ID: d5ee67ff-528b-4c63-b8c1-3cbe38ca2ee4
Crystal Westbrook
crystal.westbrook@cityofdenton.com
Senior Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 7/7/2023 1:16:49 PM
Viewed: 7/12/2023 8:38:57 AM
Signed: 7/12/2023 8:39:03 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
Procurement Administration Supervisor
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 7/12/2023 8:39:05 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jewel Lanning
jewel.lanning@cityofdenton.com
Contract Control Specialist
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 7/12/2023 8:39:06 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 7/6/2023 10:06:31 AM
Certified Delivered Security Checked 7/12/2023 8:38:57 AM
Signing Complete Security Checked 7/12/2023 8:39:03 AM
Envelope Summary Events Status Timestamps
Completed Security Checked 7/12/2023 8:39:06 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: Mike Stelzer, DAVID BROWN, Zack Dawson, Stephen D. Gay
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