6900-001 - Change Order 2 Executed
Docusign City Council Transmittal Coversheet
File Name
Purchasing Contact
City Council Target Date
Piggy Back Option
Contract Expiration
Ordinance
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10. Contract Changes Contract Unit
Price
Revised Estimated
Cost
Curb & Gutter Warren Ct $0.00 $11,400.00
Curb & Gutter Warren Ct $21.00 $3,864.00
8" Lime Treat $7.28 $15,360.80
Concrete Driveway $129.00 $45,666.00
Concrete Sidewalk $59.00 $3,186.00
Concrete Slope paving $94.00 $29,516.00
6” Concrete Intersection
Approach w/ 3” HMAC subbase $0.00 $22,575.00
Side Walk Curb Ramp $0.00 $3,900.00
Concrete Flume $39.00 $18,525.00
Irrigation Relocation $0.00 $3,000.00
36" Class IV RCP $192.91 $12,346.24PH 2, Sec 4,
Item 30 214 64 $192.91 $41,282.74
PH 2, Sec 4,
Item 24 425 475 $39.00 $16,575.00
PH 1, Sec 4,
Item 11 268 314 $94.00 $25,192.00
$0.00 NEW 0
FILE #6900-001
CITY OF DENTON CHANGE ORDER
1. Division (Department)
Engineering
2. Purchase Order No.
189745
Original Estimated
Cost
6. Date Prepared
7/14/2020
7. Name and Address of Contractor
Jagoe Public CO
3020 Fort Worth Dr, Denton Tx, 76205
4. Name of Project
3. Change Order No.
2
5. Project Acct No.
630285517 - $130,062.71
9. Changes ordered and reason ordered
650047561 - $86,355.38
Pecan Creek 4 Phases 1 & 2
8. Description of Work Included in Contract
2-11'x8' drainage boxes from Wainwright st to west of Elm st on Prairie. Water and Sewer replacements on Elm and Locust from Hickory to Eagle. Street
reconstruction along Warren Ct.
Negotiated
C.O. Unit Price
$11,844.00 564 184 $21.00
Changes include the addition of 8" water line on Walnut to connect 2 stub outs. Changes to paving and sidewalk on Warren ct for ADA compliance and drainage at
intersections. Various other small field modifications.
Bid Item No Original Estimated
Quantity
Revised
Estimate
Quantity
NEW 0
PH 1, Sec 4,
Item 9
380 $30.00 $0.00
PH 1, Sec 4,
Item 5
85 354 $129.00 $10,965.00
2,039 2,110 $7.28 $14,843.92
PH 1, Sec 4,
Item 13
54 $59.00 $531.00
$1,950.00 $0.00
PH 1, Sec 4,
Item 12 9
$0.00 NEW
NEW 0 2
175 $129.00
0 1 $3,000.00
Page 1 of 3
36" Class V RCP $0.00 $38,250.00
8" Gate Valve $1,445.05 $13,005.45
2" Water Service Connection $2,321.64 $113,760.36
12" C900 PVC Water with
Pavement Repair $167.88 $86,458.20
Fire Service Connection $4,728.27 $61,467.51
Additional Concrete MH Depth (
> 6ft deep) $160.44 $7,946.59
Excavation Protection $3.19 $12,750.43
2" Water Service Connection $2,231.32 $142,804.48
8" C900 PVC Water with
Pavement Repair $139.19 $149,629.25
Cut & Plug Existing Water Line $403.76 $3,633.84
Remove Valve Stack $116.88 $2,220.72
$801,265.87
$216,418.09
NEW 0 150 $255.00 $0.00
PH 2, Sec 3,
Item 6 46 64 $2,231.32 $102,640.72
PH 1, Sec 3,
Item 14 456 515 $167.88 $76,553.28
PH 1, Sec 3,
Item 23 6 13 $4,728.27 $28,369.62
PH 1, Sec 3,
Item 4 6 9 $1,445.05
PH 2, Sec 3,
Item 11 825 1,075 $139.19 $114,831.75
PH 2, Sec 2,
Item 7 43 49.53 $160.44 $6,898.92
PH 2, Sec 3,
Item 1 3,747 3,997 $3.19 $11,952.93
$8,670.30
PH 1, Sec 3,
Item 6 47 49 $2,321.64
TOTAL $584,847.78
11. Original Contract Price + Previous CO's
$11,212,945.51 Decrease in contract price
PH 2, Sec 3,
Item 15 7 9 $403.76 $2,826.32
PH 2, Sec 3,
Item 17 15 19 $116.88 $1,753.20
$109,117.08
12. Contract time increased/decreased by __0__days. New contract time __days.
$10,996,527.42 Increase in contract price
New Contract Price
Page 2 of 3
Project Manager
Signature
THE AFOREMENTIONED CHANGE, AND WORK AFFECTED THEREBY, IS SUBJECT TO ALL CONTRACT STIPULATIONS AND COVENANTS.
16. CITY MANAGER:
14. ACCEPTED BY CITY ENGINEER/DIRECTOR OF CAPITAL PROJECTS
13. SUBMITTED BY:
Signature
18. APPROVED AS TO LEGAL FORM:
Signature
ATTEST: CITY SECRETARY
17. PURCHASING/FINANCE:
Signature
Signature
Signature
15. ACCEPTED BY CONTRACTOR: ________________
Title
Page 3 of 3
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
Certificate Of Completion
Envelope Id: 4EB89BCB800946D8B68FD919DFE967A4 Status: Completed
Subject: Please DocuSign: City Council Contract 6900-001 - PEC4 CO#2
Source Envelope:
Document Pages: 5 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
7/16/2020 4:29:40 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: 7/16/2020 4:38:00 PM
Viewed: 7/16/2020 4:38:09 PM
Signed: 7/16/2020 4:38:11 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: 198.49.140.10
Sent: 7/16/2020 4:38:13 PM
Viewed: 7/16/2020 5:32:44 PM
Signed: 7/16/2020 5:33:05 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: 198.49.140.104
Sent: 7/16/2020 5:33:07 PM
Viewed: 7/17/2020 9:31:50 AM
Signed: 7/17/2020 9:33:01 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Bill Cheek, Jr.
billy.cheek@jagoepublic.com
Executive Vice President
Jagoe-Public Company
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 75.139.243.122
Sent: 7/17/2020 9:33:03 AM
Viewed: 7/17/2020 9:52:48 AM
Signed: 7/17/2020 10:05:55 AM
Electronic Record and Signature Disclosure:
Accepted: 5/3/2018 4:59:04 PM
ID: ac2b119c-3c87-4c64-bf45-fe6c2d41b92e
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: 68.184.181.113
Sent: 7/17/2020 9:33:03 AM
Viewed: 7/17/2020 10:47:52 AM
Signed: 7/17/2020 10:48:58 AM
Electronic Record and Signature Disclosure:
Accepted: 7/17/2020 10:47:52 AM
ID: 3ead779a-afa1-40e6-81dd-642990e8f6d5
Seth Tarcia
Seth.Tarcia@cityofdenton.com
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(None)
Signature Adoption: Drawn on Device
Using IP Address: 107.77.200.99
Signed using mobile
Sent: 7/17/2020 9:33:03 AM
Viewed: 7/17/2020 9:42:19 AM
Signed: 7/17/2020 9:42:48 AM
Electronic Record and Signature Disclosure:
Accepted: 7/17/2020 9:42:19 AM
ID: dec3bf6d-1d9e-4421-9d73-31a12bd8434b
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: 7/17/2020 10:49:01 AM
Viewed: 7/29/2020 1:09:29 PM
Signed: 7/29/2020 1:09:46 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: 198.49.140.10
Sent: 7/29/2020 1:09:48 PM
Viewed: 7/29/2020 2:07:36 PM
Signed: 7/29/2020 2:07:41 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: 47.24.6.80
Sent: 7/29/2020 2:07:43 PM
Viewed: 7/29/2020 2:22:11 PM
Signed: 7/29/2020 2:23:13 PM
Electronic Record and Signature Disclosure:
Accepted: 7/29/2020 2:22:11 PM
ID: 542111fb-a3a1-40f8-88d0-fe25b026fc46
In Ierson Signer Events Signature Timestamp
Editor DeliverI Events Status Timestamp
Igent DeliverI Events Status Timestamp
IntermediarI DeliverI Events Status Timestamp
CertiIied 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: 7/16/2020 4:38:13 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jason Roberts Tjroberts@jagoepublic.comT
jroberts@jagoepublic.com
Chief Estimator/Sr. Project Manager
Jagoe-Public Company
Security Level: Email, Account Authentication
(None)
Sent: 7/17/2020 9:33:03 AM
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: 7/17/2020 10:49:01 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Tolaina Parker
Tolaina.Parker@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 7/29/2020 2:23:15 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 7/29/2020 2:23:15 PM
Certified Delivered Security Checked 7/29/2020 2:23:15 PM
Signing Complete Security Checked 7/29/2020 2:23:15 PM
Completed Security Checked 7/29/2020 2:23:15 PM
IaIment Events Status Timestamps
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