HomeMy WebLinkAboutPeterson Contractors CO# 3, Cont No. 991 - 9.28.20 L4410WADOT
Form 331240 (01-16) '..
CHANGE ORDER
For Local Public Agency Projects '...
No. : 3 Non-Substantial:
Substantial: Administering Office
Concurrence Date
Accounting ID No. (5-digit number): Project Number: RM-$ 155(765)--9D-07
Contract Work Type: PCC Paving Local Public Agency: City of Waterloo
Contractor: Peterson Contractors, Inc. Date Prepared: 9/21 /2020
You are hereby authorized to make the following changes to the contract documents.
A - Description of change to be made:
0010 - Add Below Grade Excavation for coreout
0050 - Add quantity for additional depth of subbase material
B - Reason for change:
The prepared soil subgrade had several areas of unstable soils during proofroll. In order to provide a more stable and uniform
subgrade, an additional 6" of soil will be removed and additional 6" of modified subbase added.
C - Settlement for cost(s) of change as follows with items addressed in Sections F and/or G:
0130 - Contract unit price for below grade excavation - 2 times unit price per Section 2102.05
0220 - Contract unit price
D - Justification for cost(s) (See I.M. 3.805, Attachment D, Chapter 2.36, for acceptable justification):
E - Contract time adjustment: ® No Working Days added Working Days added: Unknown at this time
Justification for selection:
Completion Date Project
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QJ 10WAD0T Accounting ID No.(5-digit number):
Form 831240 (01-1B) Change Order No.:
F-Items included in contract:
Participating For deductions enter as
"-x.xx"
Federal- State- Line Unit Price Quantity Amount
aid aid Number Item Description xx xxx xx
X 0010 Excavation,Class 10,Roadway and Borrow $6.00 1,110.000 $6,660.00
X 0050 Modified Subbase $36.00 1,110.000 $39,960.00
Add RowDelete Row TOTAL $46,620.00
G-Items not included in contract:
Participating For deductions enter as
"-x.xx"
Federal- State- Change Item Number Item Description Unit Price Quantity Amount
aid aid Number xx xxx Ax
Add RawDelete Row TOTAL
H.Signatures
Agreed: W� 5&&4 9/23/2020
Contractor ETERSONCONTRACTORS INC.Date
Recommended: � ') 9/23/2020
Project ngineer Date
Approved: Quentin Hot 9/28/2020
Person in Responsible Charge Date Other (optional) Title Date
Contracting Authority optional Date Other (optional) Title Date
Iowa DOT Administering Office
Approval is contingent upon funds being available under the existing project agreement or upon additional Federal-aid funds being made available by a
modified project agreement.
FHWA Concurrence:
Federal Highway Division A ministration Date
(if required)
DISTRIBUTION(after fully executed on LPA projects):Original-Finance;Copies-Contractor,Project Engineer,Contracting Authority,Administering Office.
Date distributed: Initials:
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