CN-550000-E4P20-00080000.pdf

RICK SCOTT

GOVERNOR

Centennial

FD01

...1101 1.;7---r20;5

Florida Department of Transportation 3400 West Commercial Boulevard Fort Lauderdale, FL 33309-3421

JIM BOXOLD

SECRETARY

MEMORANDUM

Date: Friday, February 13, 2015

TO: Contract Payment Section M/S 42

FROM: Becky B. Johnson, District 4 Construction Contracts Administrator

COPIES: File

SUBJECT: TRANSMITTAL OF APPROVED SUPPLEMENTAL AGREEMENT

Please find enclosed the approved Supplemental Agreement/Change Order 3 dated 2/12/2015 in the amount of $0.00 and 0 days for the following project:

Scanned by:

Attributed by:

Document#:

Executed By: "r•

(SEAL)

Contractor Signature

Printed Name Title Date

15-ate

(SEAL)

Surety

BY

Florida Licensed Insurance Agent Date

Executed By:

Secretary or Designee Si Printed Name Title

--24V/S ture arolyn Gish, P.E.

Date District Construction Engineer

Printed Name Date

91/, z_\\

Attorney ignat reDepartment of Transportation, Legal Review

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

SUPPLEMENTAL AGREEMENT

No. 003 Contract No.: E4P20

Road No(s). County-Wide Federal Aid Project No(s). N/A

700-010-45

CONSTRUCTION

04/11

Fin. Proj. ID 229833-7-52-01

This agreement entered into on "t-Cb • 121 2015 , such an agreement to be effective on the last date of execution by a party hereto, by and between the State of Florida Department of Transportation, "Department", and Community Asphalt Corporation., "Contractor", and Travelers Casualty and Surety Company of America, "Surety", the same being supplementary to Contract E4P20 by and between the parties aforesaid, dated 03/04/2014, for the construction or improvement of the road(s) and bridge(s) assigned the project number(s) shown above, in Palm Beach Count(y)(ies) Florida.

(1) The Department and the Contractor hereby amend this Contract as follows:

(Continued on Page 2 attached hereto and made a part hereof)

Revised Plan Sheet Nos. N/A

(2) The quantities to be paid shall be determined as provided in the Standard Specification, Edition of 2014.

The quantities so determined shall be paid at the unit prices stated on the attached sheets.

(3) It is further agreed that this supplemental agreement shall not alter or change in any manner the force and effect of the original Contract No. E4P20, including any previous amendments thereto, except insofar as the same is altered and amended by this supplemental agreement.

(4) The Department and the Contractor agree that the contract time adjustment and sum agreed to in the Supplemental Agreement constitute a full and complete settlement of the matters set forth herein, including all direct and indirect costs for equipment, manpower, materials, overhead, profit and delay relating to the issues set forth in the Supplemental Agreement. This settlement is limited to and applies to any claims arising out of or on account of the matters described and set forth in this Supplemental Agreement.

Granted Time this Agreement 0 Days

Net Change in Contract this Agreement: Increase $ 0.00 Decrease $ 0.00 No Change E

Approved By:

Secretary or Designee Signature Printed Name Eduardo Caballero, P.E.

Title Palm Beach Operations Engineer Date

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

SUPPLEMENTAL AGREEMENT

700-010-45

CONSTRUCTION

04/11

(1) (continued):

To Provide New Pay Items to the Contract for the Installation of a Concrete Sidewalk and American Disabilities Act (ADA)

Ramps at the north side of Lake Worth Road. This additional work is necessary due to the discovery of a conflict with underground gas utilites at the referenced location and to complete Work Document Number PBC-3-2014, as requested by the Traffic Operations Division.

This is considered as a Push-Button Contract. Due to budgetary restrictions, this additional work will not increase the original contract amount of $600,000.00.

Rpt-ID: RCOCORPT

User: cn409we

Florida Date: 01/28/2015

Department of Transportation Page:A-of3-j c'-'711

Change Order Report

Contract ID: E4P20

Change Order Nbr: 003 Force Acct ID: 0

Change Order Type: Supplemental Aggreement

CO Description: To Add New Pay Items for Sidewalk & ADA Ramps-$0.00-PB

Zero Dollar Change Order: No

Project Nbr Itm Nbr Catg Item Code Unit Unit Price Bid Qty Prey Apprvd Qty Curr CO Qty Curr Apprvd Qty Amount of Change

22983375201 0051 0200 0104 15 EA $113.51 0 0 1 0 This Chng: $113.51

Prey Revised: $0.00 Item Description SOIL TRACKING PREVENTION DEVICE CO Item Description Add a New Pay Item for Mail Box, Furnish and Install

New Revised: $113.51 Supplemental Description) To Add a New Pay Item for Mail Box, Furnish & Install Bid Contract: $0.00 Supplemental Description2 (Non-Federal Participation) Net Change: $113.51

Pct Change:

22983375201 0136 0200 9999 3 LS $-14,040.69 0 0 1 0 This Chng: $-14,040.69

Item Description GENERIC CONTRACT CHANGE(S/M ONLY) CO Item Description Budgetary Ceiling Item-For Accounting Purposes Only

New Revised: $-14,040.69

22983375201 0274 0200 0415 1 6 LB $37.00 0 0 68 0 This Chng: $2,516.00

Item Description REINF STEEL- MISCELLANEOUS CO Item Description To Add a New Pay Item for Reinforcement ctoal-hilicrallanani lc New Revised: $2,516.00 Supplemental Description) To Add a New Pay Item for Reinforcement Steel-Miscellaneous Bid Contract: $0.00 Supplemental Description2 (Non-Federal Participation) Net Change: $2,516.00

22983375201 0278 0200 0425 1543 EA $11,089.10 0 0 1 0 This Chng: $11,089.10

Item Description INLETS, DT BOT,TYPE D, J BOT, <10' CO Item Description To Add a New Pay Item for Inlet Type J Structure Bottom-CIP

New Revised: $11,089.10 Supplemental Description) To Add a New Pay Item for Inlet Type J Structure Bottom, Bid Contract: $0.00 Supplemental Description2 Cast-In-Place (Non-Federal Participation) Net Change: $11,089.10

Florida Rpt-ID: RCOCORPT Date: 01/28/2015

User: cn409we Department of Transportation Page: 2-ef-2-

Project Nbr Itm Nbr Catg Item Code Unit Unit Price Bid Qty Prey Apprvd Qty Curr CO Qty Curr Apprvd Qty Amount of Change

22983375201 0279 0200 0104 18 EA $80.52 0 0 4 0 This Chng: $322.08

Item Description INLET PROTECTION SYSTEM CO Item Description To Add a New Pay Item for Inlet Protection System

New Revised: $322.08 Supplemental Description) To Add a New Pay Item for Inlet Protection System Bid Contract: $0.00

Supplemental Description2 (Non-Federal Participation) Net Change: $322.08

Total Value for Change Order 003 = $0.00

General or Standard Change Order Explanation

To Add New Pay Items to the Contract for the Installation of a Concrete Sidewalk on the North side of Lake Worth Road and American Disabilities Act

(ADA) Ramp to complete Work Document Number PBC-3-201 dated August 28, 2014, as requested by the Traffic Operations Division. This additional work is necessary due to a conflict with the existing underground gas lines at the referenced location.

To: (Attorney): JEB From: Wanda/Becky Ext.: 2248

Submittals: Date: 02/02/15 Date:

Date:

Reviewed by: Date:

Approved: I/ Subject to Comments: 0

\_5

PLEASE CLOCK HERE

nECEIVE

1 FLB 1 1 2015

L

DOT D4 OFFICE OF THE GENERAL COUNSEL

CONTRACT DOCUMENT TRACKING FORM

DIVISION (File Type):

X TRANS. OPERATIONS

CONTRACT DOCUMENT TYPE (

Adopt -A - Highway

Change Orders

Closeouts and 21-A's

Consultant Agreement

Consultant Supplemental Amendment

Contractual Services

X

Construction / Maint. Supplemental

Construction Spec. Package

TRANS. SUPPORT

RUSH 0

District Contract

Joint Participation Agreement

Joint Participation Agreement Supplemental

Joint Project Agreement

Other

Railroad Agreement

RFP / ITB

Subordination of Utility Agreement

TRANS. DEVELOPMENT

COMMENTS: THE SURETY'S SIGNATURE IS NOT REQUIRED FOR THESE DOCUMENTS

THE E-VERIFY LANGUAGE IS NOT REQUIRED FOR THESE DOCUMENTS; THE PROJECT

LETTING DATE IS 01/03/14

SUPPLEMENTAL NO: 003 AMENDMENT NO: RFP/ITB NO: ITEM SEGMENT:

STATE PROJECT NO: 229833-7-52-01 CONTRACT NO: E4P20 AMOUNT: $0.00

VENDOR/ CONTRACTOR / CONSULTANT: COMMUNITY ASPHALT CORPORATION

Not Approved: 0

COMMENTS: $(), m) 64- - fipLitioivf4tet J/Lrittacei-)

Reviewed by:

Approved: 0

COMMENTS:

Date:

Subject to Comments: 0 Not Approved: 0

Reviewed by: Date:

Approved: 0 Subject to Comments: 0 Not Approved: 0

COMMENTS: