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6894 - Change Order 3 Executed Docusign Transmittal Coversheet File Name Purchasing Contact Contract Expiration DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 6894FILE Crystal Westbrook CONSTRUCTION OF HICKORY CREEK LIFT PUMP STATION-CHANGE ORDER 4 NA EJCDC® C-941, Change Order EJCDC® C-941, Change Order, Rev.1. Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies and American Society of Civil Engineers. All rights reserved. Page 1 of 2 CHANGE ORDER NO.: 03 Owner: City of Denton Owner’s Project No.: 6894 Engineer: Hazen and Sawyer Engineer’s Project No.: 60702-004 Contractor: Rey-Mar Construction Contractor’s Project No.: N/A Project: Hickory Creek Lift Station Contract Name: Hickory Creek Lift Station Construction Date Issued: __________________ Effective Date of Change Order: ________________ The Contract is modified as follows upon execution of this Change Order: Description: Work Change Directives (WCD): 1. Installation of corporation stops for air release valve isolation. 2. Installation of two 16-inch gate valves for the hot taps upstream and downstream of the new force main tie-in. Attachments: Change Order No. 3 Summary Work Change Direct No. 12 – Corporation Stop Work Change Direct No. 13 – Two 16-inch Gate Valves Change in Contract Price Change in Contract Times Original Contract Price: Original Contract Times: Substantial Completion: 270 days $ 3,418,000.00 Ready for final payment: 290 days Change from previously approved Change Orders Change from previously approved Change Orders: Substantial Completion: 175 days $ 137,833.36 Ready for final payment: 175 days Contract Price prior to this Change Order: Contract Times prior to this Change Order: Substantial Completion: 445 days $ $3,555,833.36 Ready for final payment: 465 days Increase this Change Order: Increase this Change Order: Substantial Completion: 14 days $ 15,781.73 Ready for final payment: 14 days Contract Price incorporating this Change Order: Contract Times with all approved Change Orders: Substantial Completion: 459 days $ $3,571,615.09 Ready for final payment: 479 days DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 9/22/20219/22/2021 EJCDC® C-941, Change Order EJCDC® C-941, Change Order, Rev.1. Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies and American Society of Civil Engineers. All rights reserved. Page 2 of 2 Recommended by Engineer (if required) Accepted by Contractor By: Title: Date: Authorized by Owner Approved by Funding Agency (if applicable) By: Title: Date: DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 Project Manager 9/17/2021 Senior Buyer 9/22/2021 THIS AGREEMENT HAS BEEN BOTH REVIEWED AND APPROVED as to financial and operational obligations and business terms. _______________ ________________ SIGNATURE PRINTED NAME __________________________________ TITLE __________________________________ DEPARTMENT DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 Water Utilities Stephen D. Gay Director, Water Utilities Work Change Directive Approved Calendar No. Description Cost/(Credit) Days Change Order No. 1 - Completed 1 Extension of Monorail $9,662.68 21 Change Order No. 2 - Completed 1 Polymer Concrete Manhole $7,548.91 21 2 Plug and Check Valves $15,782.72 0 3 Replace FRP MH with Cast-In-Place MH $20,898.93 25 4 By-Pass Connection Relocation $10,437.95 0 5 FRP Wet Well Top $24,891.49 45 6 FRP MH Connection Changes $5,390.86 0 7 Submerisble Pump Credit ($41,480.00) 21 8 Wet Well Piping Modifications $3,415.31 7 9 Raise Surge Valve $2,323.31 14 10 Bollards for FRP Vents $880.34 0 11 Force Main Bypass $78,080.86 21 Total Change Order No. 2 $128,170.68 154 Change Order No. 3 12 Corporation Stops $2,654.13 14 13 Permanent 16-Inch Gate Valve $13,127.60 0 Total Change Order No. 3 $15,781.73 14 Original Contract Amount: $3,418,000.00 Previous Change Order Amount: $137,833.36 Contract Price Prior to Change Order $3,555,833.36 Revised Contract Amount:$3,571,615.09 Contract Time for Substantial Completion: 270 Contract Time to Final Completions: 290 Revised Time for Substantial Completion:459 Revised Time for Final Completion:479 Change Order Summary Hickory Creek Lift Station, Project No. 6894 City of Denton DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 EJCDC® C-940, Work Change Directive. Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 1 of 1 WORK CHANGE DIRECTIVE NO.: 12 Owner: City of Denton Owner’s Project No.: 6894 Engineer: Hazen and Sawyer Engineer’s Project No.: 60702-004 Contractor: Rey-Mar Construction Contractor’s Project No.: N/A Project: Hickory Creek Lift Station Contract Name: Date Issued: 5/17/2021 Effective Date of Work Change Directive: 5/21/2021 Contractor is directed to proceed promptly with the following change(s): Description: Installation of corporation stops for air release valve isolation instead of pipe nipple and ball valve, as shown on the Drawings. Attachments: 1. Hickory Creek LS – Corporation Stop Change Order Purpose for the Work Change Directive: To provide a more robust connection to the air release valves. Directive to proceed promptly with the Work described herein, prior to agreeing to change in Contract Price and Contract Time, is issued due to: Notes to User—Check one or both of the following ☐ Non-agreement on pricing of proposed change. ☒ Necessity to proceed for schedule or other reasons. Estimated Change in Contract Price and Contract Times (non-binding, preliminary): Contract Price: $2,654.13 increase. Contract Time: 14 days increase. Basis of estimated change in Contract Price: ☒ Lump Sum ☐ Unit Price ☐ Cost of the Work ☐ Other Recommended by Engineer Authorized by Owner By: Title: Senior Associate Date: 5/17/2021 DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 DIRECT FIELD COST Hickory Creek LS- Corporation Stop Change Order material labor rental / sub Unit Total Total Total Unit Sub / Rental Unit MH Loc.Description Qty Unit Mat'l Labor Mat'l Labor Unit Composit Rate Analysis NA Qty Description Hickory Creek LS- Corporation Stop Change Order 1.000 2" Ball Curb MIPxFIP 6.00 QY - 352.77 - - 2,116.62 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Subtotal - 2,116.62 - Burden 0%- - Subtotal - 2,116.62 - Subtotal - Sub/Rental + Labor + Material 2,116.62 Overhead 10%211.66 Subtotal 2,328.28 Profit 10%232.83 Subtotal 2,561.11 Bond 2%51.22 Subtotal 2,612.33 Insurance 1.6%41.80 Total 2,654.13 Days Extra 14.00 Job:Hickory Creek Lift Station Item:Hickory Creek LS- Corporation Stop Change Order Sht.1 of 1 Contractor Approval By:________________________________ By:________________________________ Title:_______________________________ Title:_______________________________ Date:______________________________ Date:______________________________ Unit Sub DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 FEATURES • All brass that comes in contact with potable water conforms to AWWA Standard C800 (ASTM B584, UNS C89833) • The product has the letters “NL” cast into the main body for lead-free identification • Certified to NSF/ANSI Standard 61 and NSF/ANSI Standard 372 where applicable • Brass components that do not come in contact with potable water conform to AWWA Standard C800 (ASTM B62 and ASTM B584, UNS C83600, 85-5-5-5) • Valve is non-directional and is watertight with flow in either direction • Ends are integral or secured with adhesive to prevent unintentional disassembly • Hole for attaching curb box rod or handle is provided in tee-head • 300 PSI working pressure Optional Padlock Wing for locking valve in closed position. Add “W” to part number Optional full 360° tee-head rotation. Add “R” to part number MALE IRON PIPE THREAD INLET BY FEMALE IRON PIPE THREAD OUTLET Inlet Length Solid one piece tee-head and stem Sturdy stops allow 90° motion and are enclosed and protected A snap ring locks the stem into the body of the valve Dual EPDM O-rings in the stem Molded EPDM rubber seats with reinforcing ring support the ball Female Iron Pipe Thread Fluorocarbon-coated brass ball Outlet The Ford Meter Box Company, Inc. P.O. Box 443, Wabash, Indiana U.S.A. 46992-0443 Phone: 260-563-3171 / Fax: 800-826-3487 Overseas Fax: 260-563-0167 www.fordmeterbox.com Submitted By: The Ford Meter Box Company considers the information in this submittal form to be correct at the time of publication. Item and option availability, including specifications, are subject to change without notice. Please verify that your product information is current. Our standard warranty applies. 05/13/20 Ball Valve Curb Stop - (B81-xxx-NL style) SUBMITTAL INFORMATION Male Iron Pipe ThreadOptional Padlock Wing for locking valve in closed position Vඉඔඞඍ Sඑජඍ Iඖඔඍග Sඑජඍ Oඝගඔඍග Sඑජඍ Lඍඖඏගඐ A඘඘ක඗ච. Wග. Lඊඛ. Pඉකග Nඝඕඊඍක ✓ Sඝඊඕඑගගඍඌ Iගඍඕ(ඛ) 3/4" 3/4" 3/4" 3-23/32" 1.6 B81-333-NL 3/4" 1" 1" 3-29/32" 1.8 B81-344-NL 1" 1" 1" 4-3/16" 2.0 B81-444-NL 1-1/2" 1-1/2" 1-1/2" 5-15/16" 5.3 B81-666-NL 1-1/2" 2" 1-1/2" 5-25/32" 5.2 B81-676-NL 2" 2" 2" 6-9/64" 7.7 B81-777-NL Due to design variations related to sizing, items may differ from images above. DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 EJCDC® C-940, Work Change Directive. Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 1 of 1 WORK CHANGE DIRECTIVE NO.: 13 Owner: City of Denton Owner’s Project No.: 6894 Engineer: Hazen and Sawyer Engineer’s Project No.: 60702-004 Contractor: Rey-Mar Construction Contractor’s Project No.: N/A Project: Hickory Creek Lift Station Contract Name: Date Issued: 8/3/2021 Effective Date of Work Change Directive: 8/3/2021 Contractor is directed to proceed promptly with the following change(s): Description: Installation of two 16-inch gate valves for the hot taps both upstream and downstream of the new force main tie-in location. Attachments: 1. Direct Field Cost – Hickory Creek LS- Permanent 16” Gate Valves by Rey-Mar Construction Purpose for the Work Change Directive: More robust bypass pumping for limiting potential of overflows. Directive to proceed promptly with the Work described herein, prior to agreeing to change in Contract Price and Contract Time, is issued due to: Notes to User—Check one or both of the following ☐ Non-agreement on pricing of proposed change. ☒ Necessity to proceed for schedule or other reasons. Estimated Change in Contract Price and Contract Times (non-binding, preliminary): Contract Price: $13,127.60 increase. Contract Time: 0 days increase. Basis of estimated change in Contract Price: ☒ Lump Sum ☐ Unit Price ☐ Cost of the Work ☐ Other Recommended by Engineer Authorized by Owner By: Title: Senior Associate Date: 8/3/2021 DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 DIRECT FIELD COST Hickory Creek LS- Permanent 16" Gate Valves material labor rental / sub Unit Total Total Total Unit Sub / Rental Unit MH Loc.Description Qty Unit Mat'l Labor Mat'l Labor Unit Composit Rate Analysis NA Qty Description Hickory Creek LS- Permanent 16" Gate Valves 1.000 16" AFC 2516FF FLG 2.00 QY 6,340.00 - - 12,680.00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Subtotal - 12,680.00 - Burden 0%- - Subtotal - 12,680.00 - Subtotal - Sub/Rental + Labor + Material 12,680.00 Overhead 0% Subtotal 12,680.00 Profit 0% Subtotal 12,680.00 Bond 1.5%190.20 Subtotal 12,870.20 Insurance 2%257.40 Total 13,127.60 Days Extra - Job:Hickory Creek Lift Station Item:Hickory Creek LS- Permanent 16" Gate Valves Sht.1 of 1 Contractor Approval By:________________________________ By:________________________________ Title:_______________________________ Title:_______________________________ Date:______________________________ Date:______________________________ Unit Sub DocuSign Envelope ID: 40E24A23-7951-4B3B-A482-15A7DFA94E78 Certificate Of Completion Envelope Id: 40E24A2379514B3BA48215A7DFA94E78 Status: Completed Subject: ***Purchasing Approval*** 6894--Amendment 3 Source Envelope: Document Pages: 10 Signatures: 3 Envelope Originator: Certificate Pages: 5 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 9/17/2021 10:05:05 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: 9/17/2021 10:10:26 AM Viewed: 9/17/2021 10:31:28 AM Signed: 9/17/2021 10:32:42 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Sergio Conchas Jr. sergioc@reymarconstruction.com Project Manager Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 66.169.179.199 Sent: 9/17/2021 10:32:43 AM Viewed: 9/17/2021 4:50:36 PM Signed: 9/17/2021 4:52:02 PM Electronic Record and Signature Disclosure: Accepted: 9/17/2021 4:50:36 PM ID: fe34dc4c-0030-4582-9d2e-a09d59bc9bbb Stephen D. Gay stephen.gay@cityofdenton.com Director, Water Utilities Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 9/17/2021 4:52:03 PM Resent: 9/22/2021 8:54:35 AM Viewed: 9/17/2021 10:12:46 PM Signed: 9/22/2021 8:59:43 AM Electronic Record and Signature Disclosure: Accepted: 9/22/2021 8:58:13 AM ID: 8dfd6772-3fad-4798-8418-7a6753d874a2 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: 198.49.140.104 Sent: 9/22/2021 8:59:45 AM Viewed: 9/22/2021 9:50:15 AM Signed: 9/22/2021 9:50:25 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 Chris Campbell chris.campbell@cityofdenton.com Vertical Infrastructure Manager Security Level: Email, Account Authentication (None) Sent: 9/22/2021 9:50:27 AM Electronic Record and Signature Disclosure: Accepted: 9/21/2021 10:56:11 AM ID: 60c5aa27-fb77-44cd-810b-296f1f835da6 Cheyenne Defee cheyenne.defee@cityofdenton.com Contract Administrator City of Denton Security Level: Email, Account Authentication (None) Sent: 9/22/2021 9:50:27 AM 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: 9/22/2021 9:50:27 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 9/17/2021 10:10:26 AM Certified Delivered Security Checked 9/22/2021 9:50:15 AM Signing Complete Security Checked 9/22/2021 9:50:25 AM Completed Security Checked 9/22/2021 9:50:27 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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