Form of Change Order 010/9--3ayez
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FORM OF CHANGE ORDER
CHANGE ORDER FORM
Date: 05/24/2019
To: Design/Builder
Reason:Extra Cost for Sunset Harbour
Pump Station Retrofit and Drainage
Improvements Project
1. CHANGE IDENTIFICATION:The following changes are hereby made to the above-referenced Contract:
Descripllon P >t, Q attialPrZO RIC
Backflows-Additional work
Backflow
prevention 16 EA $3,333.33 $53,333.28
valves
Roof Drain Re-Routes-Additional Work
Roof drains 3 EA $12,777.78 $38,333.34
Micro Pump Stations-Additional Work
Installation
of Micro 3 EA $22,222.22 $66,666.66
TOTAL $158,333.28
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2. ADJUSTMENT TO CONTRACT AMOUNT: As consideration for the change(s)identified in Section 1,
the Contract is increased/(decreased)by:
DOLLARS $ $158,333.28
Original Contract Amount: $ $2,040,460.00
Net of Previous Executed Change Orders: $ $24,064,971.74
Amended Contract Amount(prior to this Change Order): $ $26,105,431.74
The Amount of this Change Order: $ $158,333.28
Revised Contract Amount: $ $26,263,765.02
IF NO ADJUSTMENT IS MADE, THE CONTRACT AMOUNT REMAINS UNCHANGED.
3. ADJUSTMENT TO TIME FOR PERFORMANCE: In connection with the change(s) noted in Section 1,
DESIGN/BUILDER'S TIME FOR PERFORMANCE REMAINS UNCHANGED unless specifically noted herein:
Adjustment in Time: 168 Days
This Change Order is an amendment to the Agreement between the Design/Builder and City. The amount and time change
designated herein are the maximum agreed to by both the City and Design/Builder for this Change Order. Design/Builder
attests that the Contract adjustment provided herein is reasonable, and constitutes compensation in full for all costs, claims,
markup, and expenses, direct or indirect, attributable to this or any other prior Change Orders, including but not limited to
compensation in full for any delays, acceleration, or loss of efficiency encountered by Design/Builder in the performance of
the Work through the date of this Change Order, and for the performance of this and any prior Change Orders by or before
the date of Substantial Completion. In consideration of the compensation and time, if any, in this Change Order, the
Design/Builder hereby releases the City from all Claims,demands,or causes of action arising out of the transactions,events
and occurrences giving rise to this Change Order.
EXCEPT AS EXPRESSLY MODIFIED HEREIN, THE TERMS AND CONDITIONS OFT E CONTRACT,PURSUANT TO
!TB 060-2013-TC/DESIGN-BUILD SERVICES,REMAIN UNCHANGED.
Ci : DeslignlBu Iden.
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