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CONTRACT CHANGE ORDER FORM
1Q Mr. Steve Striplett CONTRACT CHANGE ORDER NO.: 1
151 Paving DATE: 9.1.2011
P.O. Box 1540 PROJECT' NAME: Maplehurst Annexation Sewer Project
New Albany, IN 47151 ORIGINAL CITY P.O. NO.:
I. You are directed to make the following changes to this Contract:
ITEM AMOUNT SCHEDULED ADJUSTMENT
f +l or ( -1 DAYS
HMA Surface Overlay Reduction of 275 Tons for Clearview and U/S Road $- 18,425.00
8" SAN. SEWER SDR 35 Reduction of 219 1.f. of pipe $ - 9,603.15
8" SAN. SEWER SDR 26 Reduction of 425 It of pipe $ - 1,821.55
MANHOLE TYPE "B" Addition of 1 manhole $ 2,083.00
PROPERTY SERVICE CONN. Reduction of 1 PSC $ 4,500.00
IJMA SURFACE OVERLAY Addition of 280.41 Tons $ 18,787.47
TOTAL $ - 10,479.23
11. The following referenced documents further describe the changes outlined in Paragraph I, and are
to be considered part of this Change Order:
R.F'.P.: _ W.D.C.:
1I1. The changes result in the following adjustment of Contract Price and Contract Time:
Contract Sum Prior to this Change Order $_570,700.93
Contract Sum will be increase/decrease by this Change Order $
New Contract Sum including this Change Order $_560,221.70
Contract Time Prior to this Change Order _N/A Substantial Completion Date
N/A Final Completion Date
Net Inaease /decrease resulting from this Change Order _0_ Days
Current Contract Time including this Change Order_,_ N /A_ Substantial Completion Date
N/A Final Completion Date
This Change Order is for full and final Settlement of all direct, indirect, impact costs and time extension
incurred at any time resulting from the performance of the changed work.
The Above Changes Are Date: , -/'n
Recommended: StsFSterovrat(, M 47
City/State/Zip
r ••77 OF ° Sip.'Fti*Vvine
Engineer By: ar
47 4LKnrtw.aa�t Cr. Phone: (4a) Z5r -1476
Address
Jeffersonville, Indiana Additional Forms Supplemental to Agreement Form
Tenth Street Pump Station Expansion 00 5225
•
The Above Changes are
Accepted:
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Contractor P,tL 'co
Z6 -n± - 46-r -.t) goxtS1-w
Address N' . = . /J 4 Z t S
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City/St e1Zip 4,r By- .1 .. !�:_ �aai
Phone: 0 -9 -3 775 7
Date: 9' 7— ,901/
Approved:
City of Jeffersonville
Owner
500 Ouartermaster Court
Address
Jeffersonville. Indiana 4713Q
City tate/Zi /
By, / /` "
Phone:
Date:
Jeffersonville, Indiana Additional Forms Supp]emental to Agreement Form
Tenth Street Pump Station Expansion 00 52 25