7568 - Change Order 1 Executed
Docusign Transmittal Coversheet
File Name
Purchasing Contact
Contract Expiration
DocuSign Envelope ID: 9A93675A-894C-45E4-B491-049A2D00DD23
7568
PUBLIC DISPOSAL FACILITY-CO #1
NA
Crystal Westbrook
FILE
Contractor:Hammett
Address
City, State Zip
Contact Name
Public Disposal Facility CHANGE ORDER NO.1
60489 PO #: 197061
Contract BID A 2,297,120.31$
5% Contingen 114,856.02$
2,411,976.33$
Prior Approve -$
Available Con 114,856.02$
$25,949.83
Contingency 88,906.19$ 250
Item
No.
Spec.
Sectio
n No.
UOM BID QTY +/- QTY Unit Price Extended Price
1 SF 32,380 1,552 8.16$ 12,664.32$
2 LF 0 168 28.00$ 4,704.00$
4 LS 0 1 5,196.75$ 5,196.75$
5 Profit and Overhead LS 0 1 3,384.76$ 3,384.76$
‐$ ‐$
$25,949.83
$0.00
Item
No.
Spec.
Sectio
nNo
UOM BID QTY +/- QTY Unit Price Extended Price
-$
4/23/2022
New Completion Date:
4/23/2022
This CO Days Request:
Total NTE Amo This CO Other Funding Request:
Project
Scope
included in
CONTINGENCY ALLOWANCE AUTHORIZED (CAA) CONTRACT CHANGES
QUANTITY CHANGES TO EXISTING ITEMS
TOTAL CAA QTY CHANGES:
NEW ITEMS OF WORK
Description of work
Additional work requested by The City.
2,297,120.31$
Notice To Proceed Issued:
8/16/2021
Current Completion Date:
<PM Name>, Project Manager Art Garcia
CITY OF DENTON CHANGE ORDER FORM
City of Denton - Solid Waste
1527 S Mayhill Road
Denton, TX 76208
Project:
New Contract Days:
Total Change Request:25,949.83$
Reason for change:
RFP#
This CAA
Request:
PROJECT SCOPE AND REASON FOR CHANGE
Prior Approved Other Funded CO's:-$
Current Contract Amount w CO's:
Orig Contract Days:
Approved CO Days:
250
0
8" Paving West Side
Doweling West Pavement
Additional Supply Wire from Service Pole
Contingency funds are used at City's discretion per contract spec language
OTHER FUNDED CONTRACT CHANGES (CO)
QUANTITY CHANGES TO EXISTING ITEMS
Description of work
N/A
TOTAL CAA NEW ITEMS:
DocuSign Envelope ID: 9A93675A-894C-45E4-B491-049A2D00DD23
$0.00
‐$ ‐$
$0.00
$25,949.83
2,297,120.31$
2,411,976.33$
Public Disposal Facility 25,949.83$
-$
2,323,070.14$
22.59%
1.13%
0%
Signatory Lines will be updated by Purchasing if required
SUBMITTED BY:_______________________________
ACCEPTED BY CITY ENGINEER/CONSULTANT:_______________________________
ACCEPTED BY CONTRACTOR: ____________________________________________________________
Name, Title
PURCHASING :_______________________________
DEPARTMENT DIRECTOR:_______________________________
TOTAL OTHER FUNDED NEW ITEMS:
THE AFOREMENTIONED CHANGE, AND WORK AFFECTED THEREBY,
Revised Contract Amount:
Percent Changes over NTE:
TOTAL CO AMOUNT:
Total Change Order over Original Bid:
Total CO's:
% of CAA Approved To-Date:
Total CAA's:
Original Total Not To Exceed Amount:
Original BID/Contract Amount:
N/A
NEW ITEMS OF WORK
TOTAL OTHER FUNDED QTY CHANGES:
IS SUBJECT TO ALL CONTRACT STIPULATIONS AND COVENANTS.
Signature
Signature
Signature
Project Manager
Signature
]
DocuSign Envelope ID: 9A93675A-894C-45E4-B491-049A2D00DD23
Gregory Adams
Arturo Garcia
PresidentGAYLON HAMMETT
Brian Boerner
Crystal Westbrook
1545 CR 2917
Dodd City, Texas
75438
903-623-3040
City of Denton Quote Date:2/8/22
Denton Disposal Additional Electrical
Item Description Unit Qty Unit Cost Total
1 Install single phase 200 amp 120/240v LS 1 5,976.26$ 5,976.26$
Total:5,976.26$
DocuSign Envelope ID: 9A93675A-894C-45E4-B491-049A2D00DD23
1545 CR 2917
Dodd City, Texas
75438
903-623-3040
City of Denton Quote Date:2/8/22
Denton Disposal Additional Paving
Item Description Unit Qty Unit Cost Total
2
Additional 8" Paving & Additional
Doweling LS 1 19,973.57$ 19,973.57$
Total:19,973.57$
DocuSign Envelope ID: 9A93675A-894C-45E4-B491-049A2D00DD23
Certificate Of Completion
Envelope Id: 9A93675A894C45E4B491049A2D00DD23 Status: Completed
Subject: ***Purchasing Approval*** 7568-Change Order #1
Source Envelope:
Document Pages: 5 Signatures: 5 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: 198.49.140.10
Record Tracking
Status: Original
8/30/2022 8:15:11 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: 198.49.140.10
Sent: 8/30/2022 8:19:33 AM
Viewed: 8/30/2022 8:19:41 AM
Signed: 8/30/2022 8:20:29 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Gregory Adams
gadams@biggsandmathews.com
Principal
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 128.92.63.242
Sent: 8/30/2022 8:20:30 AM
Viewed: 8/30/2022 9:50:52 AM
Signed: 8/30/2022 9:59:30 AM
Electronic Record and Signature Disclosure:
Accepted: 8/30/2022 9:50:52 AM
ID: 8c25ab98-e075-4a10-a621-a99cb323eb9d
Arturo Garcia
Arturo.Garcia@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 8/30/2022 9:59:31 AM
Viewed: 8/30/2022 11:24:40 AM
Signed: 8/30/2022 11:25:25 AM
Electronic Record and Signature Disclosure:
Accepted: 8/30/2022 11:24:40 AM
ID: 8d5610d9-75c0-4a76-9c11-82e390c11463
GAYLON HAMMETT
gaylon@hammett-excavation.com
President
Hammett Excavation, Inc
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 172.108.176.202
Sent: 8/30/2022 11:25:27 AM
Viewed: 8/31/2022 5:01:04 PM
Signed: 8/31/2022 5:01:33 PM
Electronic Record and Signature Disclosure:
Accepted: 1/27/2021 5:33:29 PM
ID: 89c4faab-4f90-4aa1-b842-3181a6ab6282
Signer Events Signature Timestamp
Brian Boerner
brian.boerner@cityofdenton.com
Director of Solid Waste
Security Level: Email, Account Authentication
(None)Signature Adoption: Drawn on Device
Using IP Address: 38.65.73.7
Signed using mobile
Sent: 8/31/2022 5:01:35 PM
Viewed: 8/31/2022 5:10:07 PM
Signed: 8/31/2022 5:10:46 PM
Electronic Record and Signature Disclosure:
Accepted: 8/31/2022 5:10:07 PM
ID: a1350a9a-7e13-4fb7-84e0-976d383f3364
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: 8/31/2022 5:10:48 PM
Viewed: 9/1/2022 8:18:22 AM
Signed: 9/1/2022 8:18:47 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: 9/1/2022 8:18:49 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 8/30/2022 8:19:33 AM
Certified Delivered Security Checked 9/1/2022 8:18:22 AM
Signing Complete Security Checked 9/1/2022 8:18:47 AM
Completed Security Checked 9/1/2022 8:18:49 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
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Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM
Parties agreed to: Gregory Adams, Arturo Garcia, GAYLON HAMMETT, Brian Boerner
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