HomeMy Public PortalAboutChange Order No. 1 to Contract No. 62-2020 - Engineering - Butler Fairman & Seufert - Professional Services - Whitewater Gorge Connector Trail - INDOT e
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Contract No:R-41306 Change Order No.: 001
INDIANA Department of Transportation Page: 1
Construction Change Order and Time Extension Summary
Contract Information Contract No.: R-41306 Letting Date:11/10/2020
District:GREENFIELD DISTRICT AE:Prather, Michael PE/S:Whitesel, Chad Status:Draft
Change Order Information Change Order No.: 001 EWA:Y or Force Acct: N
Date Generated: 00/00/0000 Date Approved:00/00/0000
Reason Code: CHANGED COND, Constructability Related
Description: Non Removable Fiowfili
Original Contract Amount $ 1,388,682.00
Current Change Order Amount $ 10,971.00 Percent: 0.790%
Total Previous Approved Changes $ 0.00 Percent: 0.000%
Total Change To-Date $ 10,971.00 Percent:0.790%
Modified Contract Amount $ 1,399,653.00
Time Extension Information
Date Initiated 00/00/0000 Date Completed 00/00/0000 •
Original Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SP Date 00/00/0000 or SP Days
(SS = Standard Specification, SP=Special Provision)
Time Element Description:
Current Time Extension SS Days 0 SP Days 0 SP Days Value$ 0.00
Previous Time Approved SS Days by AE: • DCE: SCE: DDCM:
SS Days SP Days Value$
Revised Contract Time SS Completion Date 00/00/0000 or SS Calendar/Work Days 0
SS Date 00/00/0000 or SP Days 0
Contract No:R-41306 Change Order No.: 001
INDIANA Department of Transportation Page:2
Construction Change Order and
Time Extension Summary
Review and Approval Information P.S —.
Required Approval Authority AE: ° DCE: SCE: *DDCM:
($ per Change Order) (-LE$250K-) (-LE$750K-)(—LE$2M—) (—GT$2M— )
(Days per Contract) (50 SS days) ( 100 SS days )(200 SS Days ) ( GT 200 SS days)
Verbal Approval Required? Y/(1lf Y, by Date Issued
Total Change To-Date>5%? Y./0 If Y, Copy to Program Budget Manager
Scope/Design Recommendation Y/I0If Y, Referred to Project Manager(PM)
Required?
Date to PM Date Returned
Approval Authority Concurs with PM? Y I N If Y, Concurrence by Date
If N,Resolution:Approved Disapproved
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. Resolved by Date
LPA Signatures Required? . . /N If Y, Date to LPA 7* z 1 Date Returned t /2- 2/
FHWA Signatures Required? Y/X'If Y, Date to FHWA Date Returned
*Field Engineer Recommendation (Required for SCE or DDCM Approval)
Field Engineer Date
Comments:
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•Contraot -41306 INDIANA .Date;08/.05/2021-
Change Order No;001 Deportnient of tionsportatkm Po:g-e:3
Contract. ' 41.$0.$
Project 1702760 $tete:1702760 QOLC3 .• •
Ch$Oge OrderNbt. 0.0 1.
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'Change Order i)0001)ticrr 'INIoni•Reittovobia-Filawnit
fze.@ .(4rf COO: eliANGE171CONI ,goKeteuetetglity:Related
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ci44I1CN PLN Item Code Unit Unit Price CO Qty Comment Amotrnt Chance
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NAB 1702760- .004 2120969 CYS 146.280•:: • .7.k40.0. 0. Amount 0.971:do:
Rent Do.sd.rIptfori:FI;CilktiNEM.g BACKEI.U.istiIsh.RORWA81:E•
stvPiet.tiontai•UtAstrfP.tioiti!
$upplementet.neeMption2;
• TotalValuefiltCharg4oglet0di re-$t007i.00:
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Whareat.,ttO StenderdStiealfioattensiOttbiS•contract OtiWidati.forse4griWOrk-tiibe•PtqfOrnli4ittet.ollOWIng.chenpe lsracommended
General or Standard Zhangeli.itief ExbimatIon:
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This Change.Order Covers the cost:Of ifowable fill fo sanitary sewer tiencif backlifotwOrkby.:Riehincitirt-S.arig4ry DIStrfe.t that crosses the
Orolj,st.Thlibork is Sevier teiletracftertnote4;intOfets batitqveffOrrhart•Iolishatetid.aariitars(Gistrict that•perlienOchlerly crosses the ttail .
•alignment thetrench.baoteiltis.befovilhe limits et.aerthwiirk.bit 114154 HeVieVer,in tO*11400.artatAirt.all fill Is being Placseck•b.S,the
Sante.coPtNotottiliclertfutralt,this-worlds being added to vie..qonteoet.Trhe.efiaa in weatiorl is aiTibirlitately:.Station:113+68 to 16+80 and.213
*feet wide!The trench ishelnR#44frortaPPOkifnetelY 12 ihr.h.es0Ovei.f4eanitary.sewar to theelevatlon otiiiiiionornit for the-tRail.*e
•attached 0190.rdoet•tianiitootacofpriorria forti.ttierinfbmratlort Ttfe.0bit price w4ctie'6150 eggintt tha ayerafgogstliVex,.and It is tent!to
.tie withlttithe.rangesenticipatto to be due extrawork at this Al-Ogit`)We have retileNed thie..dient*OrdOt•with the aree•endineer and engineer
otrecoklesd.thetehalotatofrctlitodJsbnddedlbrlihlswork
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battwouer porgnotou 'Item
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the:IntOnt orthe partle4:thaft.tis change•ortie!te hill end cOmprette corrip.erisetton.Tor the:work deaciiiheabove,
Notification and consent to this change order hereby acknowledged
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Caritradtor: UrtiteefrobAsttudtion Seri/ides; LW.. • . . •zigrwitk. - •
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NOT cither•requirect•atate•anclFHWA et.gegitirres.wIll obtaineikelecti.enicelly throKiblite...8itetkriarlagereystern:
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Contract No:R-41306 INDIANA Date:07/22/2021
Change Order No:001 Department of Transportation Page: 4
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APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION
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Approval Level Name of Approver ' Date Status