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Home My WebLink AboutResolution - 2017-R0488 - Change Order 001 - CSA Construction - 12/18/2017Resolution No. 2017-RO488 Item No. 6.11 December 18, 2017 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Change Order No. 001 to that certain Contract No. 12943 by and between the City of Lubbock and CSA Construction, Inc., for North and South Water Treatment Plant Improvements per Bid # 16-12943-TF, and related documents. Said Change Order No. 001 is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on December 18, 2017 DANIEL M. POPE, MAYOR ATTEST: - P, 0 JO /-f F, - J(�� Re ecca Garza, City Secret y APPROVED AS TO CONTENT: Michael G. Keenum, P.E., City Engineer APP OVED AS TO FORM: l�wh. e-11i Leisure, Assistant City Attorney ccdocslRES.ChgOrd#00I.Contract#I2943.North and South Water Treatment Plant Improvements 1 1.14.2017 Office of Purchasing and Contract Management Change Order Contract NoAW IZa,43 Contractor: CSA Construction, Inc. Change Order No: 001 Contract Title: North and South Water Treatment Plant Improvements Bid/RFP No: 16-129" TF Project No: 91032.9241.30000/92353.9241.30000 0425-021-01 tzR93 "Change Order" means a written order to a Contractor, executed by the Owner, in accordance with the Contract authorizing an addition to, deletion from, or adjustment or revision of the requirements of the Contract documents, or an adjustment to the compensation payable to the Contractor, or to the time for performance of the Contract and completion of the project, or a combination thereof, which does not alter the nature of project and is an integral part of the project objective. Adjustments to "Estimated Quantities" to a line time in a Unit Price Contract do not require a Change Order. All work that alters the nature of the construction or that is not an integral part of the project objective must be let out for public bid. Description of Change (alteration, deviation, addition, or deletion) caused by conditions encountered during construction not covered by the s ecincanons ano arawin s or me ro ecr tattacnea aamnonai pages is necessary: PCM001 North Plant -Additional duct bank to connect the North Plant main switchgear electrical feed to project scope. PCM002 — North Plant — Block credit from changing Disinfection veneer block to straight block from split face. PCM003 — South Plant — Additional core holes to enable new chemical piping. PCM004 — North Plant — Relocation of existing plant fiber optic cables to clear project defined conduit of electrical feed. PCM006 — North Plant — Electrical feed change from additional pump house junction box to the control room MCC. PCM008 — South Plant — Additional coupling material for proper piping connections. Contractor has requested 38 additional days to complete the work for these contract changes Where the Change Order is negotiated, the Change Order must be fully documented and itemized as to costs, including material quantities, material costs, taxes, insurance, employee benefits, other related costs, profit and overhead. Where certain unit prices are contained in the initial Contract, no deviations are allowed in computing negotiated change order costs. ITEMIZED COSTS MUST BE FULLY DOCUMENTED AND ATTACHED TO THIS FORM. ITEM DESCRIPTION AMOUNT A. ORIGINAL CONTRACT VALUE: $8 618 000.00 B. AMOUNT OF THIS CHANGE ORDER: Note: Council approval required if +/- $25,000 $69 627.00 COST CENTER:6211 I ACCOUNT: 91032.9241.30000/92353.9241.30000 C. PERCENT OF CONTRACT VALUE THIS CHANGE ORDER /A .008% D. AMOUNT OF PREVIOUS CHANGE ORDERS: $0.00 E. TOTAL AMOUNT OF ALL CHANGE ORDERS B+D $69 627.00 F. PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E/A): 25% maximum .008°% G. NEW CONTRACT AMOUNT A+E : $8 687 627.00 It is mutually agreed that the above dollar amount and the time extension, as applicable, as set forth in this Change Order constitutes full compensation to the Contractor for all costs, expenses and damages to the Contractor, whether direct, consequential or otherwise, in anyway incident to, or arising out of, or resulting directly or indirectly; from the work performed or modified by the Contractor under this Change Order. (1) Contractor (5) Capital Project Manager over (7) Mayor 11 /01 /2017 Date A ate Date (2) ProjqFt Architec gineer 12/18/2017 Date (8) Secretary 2017-11-01 Date ov 13 2017 Date < <'1 't Date 12/18/2017 Date Council Date: December 18, 2017 Agenda Item #: _ 6.11 Resolution #: 2017-RO488 r FREESE ? MNICHOLSS PROPOSED CONTRACT MODIFICATION (4.41 / PROJECT. Improvements to the North and South WTPs II PROJECT NUMBER: OWNER: City of Lubbock 91032.9241.3000 BUILDER: C.S.A. 1603 ENGINEER: Freese & Nichols, Inc. LUB16498 DESCRIPTION: Ductbank to MCC-RM Power Feed PCM No: 001 NOTIFICATION TO BUILDER: The Owner proposes to make the additions, modifications or deletions to the Work described in the Contract Documents as shown in Attachment "A". We request that you take the following action within 10 calendar days: Notify us that you concur that this change does not require a change in Contract time or amount. A Field Order will be issued. X Submit a Price/Credit Proposal with detailed cost breakdown of labor, materials, equipment and all other costs related to this change. Impacts on Contract Time shall be shown in a revised schedule, included with the submitted proposal. Proceed with the change. Payment will be made at the unit price bid. Proceed with the change under the time and materials provisions of the Contract. Authorization to proceed with changes must be approved by the Owner through Change Order in accordance with the Contract Documents. By: Brian Beach Date: BUILDER'S RESPONSE: We respond to your request as follows: We propose that this is a no cost or time change. Issue Field Order. X We submit the attached Price/Credit Proposal with detailed cost breakdown and revised schedule for performing the described change. We are proceeding with the change at the unit price bid. We are proceeding with the change under the time and materials provisions of the Contract. By: Brian Beach Date: ACTION TAKEN: Proposed Contract Modification rejected. See comments. Field Order will be issued. X Change Order will be issued. By: Brian Beach Date: PROPOSED CONTRACT MODIFICATION ATTACHMENT A The Owner proposes to make the following additions, modifications or deletions to the work described in the Contract Documents. Authorization to proceed with these changes must be approved by Field Order or Change Order in accordance with the Contract Documents, prior to commencing the work involved. Site for proposed change viewed from the North. Running conduit from existing conduit stub out at far right to existing conduit from removed transformers. --a View from West Side of PCM site. Running conduit from existing conduit stub out at right to existing conduit stub out on left of picture By: Byron Stickney Date: 3/28/2017 CSA CONSTRUCTION, INC. 2314 McAllister Road Houston, TX 77092 P: 713-686-8868/F: 713-689-8889 C5 OWNER: City of Lubbock, Texas PROJECT: Improvments to the North & South WTP's ENGINEER: Alan Plummer CM: Freese & Nichols CONTRACTOR: CSA Construction, Inc. PREPARED BY: George Craig DATE: March 10, 2017 DESCRIPTION OF CHANGE: New Ductbanks, Conduit, Tap Box at the existing Switchgear Building for MCC-RM Power Feed. DESCRIPTION LABOR QUANTITY UNIT TAXABLE EXEMPT TOOLS & EQUIP MATERIAL TOTAL UNIT TOTAL UNIT TOTAL TOTAL Additional Electrical work per above description 1 Is - - 28,524.00 28,524 28,524 SUBTOTALS Clarifications 1. SCl/CSA requests an additional 30 days. - 28,524 28,524 OHBP 10% 2,852 Total 31,376 C System Control & Instrumentation 11218 IH-10 EAST, CONVERSE, TX 78109 SYSTEM CONTROLS & INSTRUMENTATION 210-661-9901 (Office) 210-666-5575 (Fax) PROPOSAL SUBMITTED TO: CSA PROJECT NAME: Lubbock North WTP Change Order 001 Ductbank for MCC-RM power feed CONTACT: George PHONE: ':1111111111 SCOPE OF WORK: Installing new ductbank (2) 4" conduits from old transformer pad to the existing (2) 4" spare conduits at the northeast courner of the Switchgear building. Install a tap box (NEMA 3R) on the old transformer pad and a pull box (NEMA 4X) at the existing spare conduits at the northwest corner of the switchgear building. TOTAL AMOUNT $28,524.36 Additional Days: 30 additional days are required for this work from the date of the signed Change Order and Notice to Proceed with this work is received, subject to availability of personnel when signed Change Order is received, to the extend personnel are unavailable, the time extension will/must be extended to the extent necessary to allow personnel availability for this work and arrival of the equipment and materials. EXCLUSIONS: 1. Sales tax. 2. Asphalt repairs to the road, removal and re -installing the fence to the manhole and all other exception as stated on the contract. 3. Any other materials or equipment not listed on this Proposal This Proposal may expire in 30 days or upon written retraction by SCI. If you have any questions regarding this Proposal, please give me a call. SUBMITTED BY: System Control & Instrumentation, Ltc Michael Jarrett 2/8/2017 Project Manager Date System Controls & Instrumentation, Ltd. 11218IH-10 E. Converse, TX 78109 PAGE Phone: (210) 661-9901 Fax: (512) 666-5575 Description Ref Ref Amount Op Rate Amount Material Material Total= See Attachment $11,957.19 x 1.00 11957.19 Shipping Costs 0.00 Subtotal 11957.19 Direct Labor Project Manager Per Hour 1.00 x 75.00 75.00 Superintendent Per Hour 12.10 x 65.00 786.50 Electrician Per Hour 121.00 x 55.00 6655.00 Instrument tech Per Hour 0.00 x 55.00 0.00 La°b& Ad ustrhent, Elevated Work 10'-20' 0.00 Programmer Per Hour 0.00 x 85.00 0.00 Estimator Per Hour 1.00 x 60.00 60.00 Subtotal 7576.50 Indirect Labor Submittals & O&M Manuals Calc 0.00 x 33.00 0.00 Testing Calc 0.00 x 45.00 0.00 Training Calc 0.00 x 45.00 0.00 Drawings Calc 1.00 x 33.00 33.00 Purchase Agent Calc 1.00 x 40.00 40.00 Procurement Calc 1.00 x 20.00 20.00 Subtotal 93.00 Labor Burden Percent 7669.50 % 45.00 3451.28 Travel Lodging Per Day 0.00 x 75.00 0.00 Meals Per Day 0.00 x 30.00 0.00 Subtotal 0.00 Equipment Equipment Rental See Attahment Tools Labor Total 11120.78 % 3.00 333.62 Expendable Material Total 11957.19 % 3.00 358.72 Procrement Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Electrician/Super/Tech Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Programmer Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Subtotal 692.34 Subtotal Liability/Builters Risk Insurance + Bond 23770.30 % 0.00 0.00 23770.30 Job total OVERHEAD & PROFIT Job Subtotal 23770.30 % 20.00 4754.06 $28,524.36 SUBCONTRACTOR 0.00 % 5.00 0.00 $0.00 BOND 28524.36 % 1 0.00 0.00 BID TOTAL $28,524.36 System Controls S Instrumentation 11218 IH-10 E. Converse, TX Page 2 Material Item Vendor/Units QTY Unit Material Adj Material Extended Labor Unit Labo Adj Labor Extended see attached takeoff 1 $11,957.19 1.00 $11,957.19 121.0000 1.00 121.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 1 0.0000 1.00 0.0000 $0.00 Total Materials: 1 1.00 $0.00 $11,957.19 1 0.0000 1.00 Total Labor. 0.0000 121.0000 Combined All - Job File Pricing JOB 365 426: Lubbock MCC-RM Feeder (Company Name) PRINTED 3/2/2017 2:00:22 PM ESTIMATE 1 426: Lubbock MCC-RM Feeder (Company Address 1) MATERIAL Primary DATA SET 1 Comm Indust TSC/EST 09/05 (Company Address 2) LABOR Primary (Company Address 3) (Company Phone) / (Company Fax) (Company Email) NOTES Item Material Labor (Size _ Item Desc I Qtyj_ UOMIMat Uniti MatAdj4 Mat Ext! Lbr Unit i LbrAdji Lbr Ext Pull Box 1.00 2000.00 1.00 _ 2,000.00 2.0000 1.0000 2.0000 Gutter 1.00 2415.25 1.00 2,415.25 2.0000 1.0000 2.0000 Strut Feet 6.00 65.00 1.00 390.00 0.5000 1.0000 3.0000 4" PVC SCH 40 UGRD 96.00 FEET 5.28 1.00 50688 0.0550 1.0000 52800 4" ALUM CONDUIT 20.00 FEET 25.41 1.00 50820 0.1310 1.0000 21 6200 4" PVC ADPT/FEMALE 4.00 EACH 5.78 1.00 23 12 0.2500 1.0000 1 0000 4" LOCKNUT 4.00 EACH 7.76 1.00 31 04 0.0800 1.0000 0 32.00 4" BONDING BUSHINGS -INS 4.00 EACH 42.60 1.00 170.40 0.9500 1.0000 3 8000 4" CUT/THREAD-LABOR 8.00 EACH Skip 1.00 000 1.2500 1.0000 100000 4" PVC EXPANSION COUP 4.00 EACH 485.00 1.00 1,940.00 0.6000 1.0000 2 400u 4" ALUM MYERS HUBS 4.00 EACH 35.23 1.00 14092 0.8000 1.0000 3.200 ) 1/4. S.S.FLAT WASHERS 10.00 EACH 0.25 1.00 250 0.0500 1.0000 0.5000 3/8. S.S.FLAT WASHERS 10.00 EACH 0.25 1.00 2.50 0.0600 1.0000 0.6000 1/4-20 S.S.HEX NUTS 10.00 EACH 0.25 1.00 2.50 0.0500 1.0000 0.5000 3/8-16 S.S.HEX NUTS 10.00 EACH 0.25 1.00 2.50 0.0700 1.0000 0.7000 4" S.S.STRUT STRAPS 8.00 EACH 4.00 1.00 32.00 0.0600 1.0000 0.4800 1-1/2 PVC CTD CHANNL 30.00 FEET 13.33 1.00 399.90 0.1000 1.0000 3.0000 1 1/2" PVC CTD RITE -ANGLE 4.00 EACH 2.25 1.00 9.00 0.1100 1.0000 0.4400 4/0 BARE CU STR 48.00 FEET 4.32 1.00 207.36 0.0220 1.0000 1.0560 4/0 AUCU CRIMP LUG 4.00 EACH 16.05 1.00 64.20 0.7200 1.0000 2.8800 500 AUCU CRIMP LUG 12.00 EACH 42.36 1.00 508.32 1.1200 1.0000 13.4,100 4X2 BASE SPACER 20.00 EACH 2.01 1.00 40.20 0.0200 1.0000 0.4000 18W X 36D HAND DITCHING 48.00 FEET 8.00 1.00 38400 0.3000 1.0000 14.4000 18W X 36D BACKFILL HAND DITCH 48.00 FEET 8.00 1.00 384.00 0.3000 1.0000 14.4000 6" WARNING TAPE PLAS 48.00 FEET 0.75 1.00 36.00 Manual 1.0000 0.0000 #5 STEEL 200.00 FEET 0.90 1.00 180.00 0.0300 1.0000 6.0000 3000# CONCRETE 3.00 CYD 125.00 1.00 3715.00 2.0000 1.0000 6.0000 4" PVC COATED GRC 40MIL 20.00 FEET 30.63 1.00 612.60 0.4370 1.0000 8.7400 4" PVC COATED ELB 40MIL 4.00 EACH 147.20 1.00 588.80 2.9900 1.0000 11.9600 Grand Totals F 11,957.19 F 121.1160 Dann I of 1 FREESE ?NICHOLS PROPOSED CONTRACT MODIFICATION 4.41 / PROJECT: Improvements to the North and South WTPs II PROJECT NUMBER: OWNER: City of Lubbock 91032.9241.3000 BUILDER: C.S.A. 1603 ENGINEER: Freese & Nichols, Inc. LUB16498 DESCRIPTION: Change Split Face Block to Plain Grey Block PCM No: 002 NOTIFICATION TO BUILDER: The Owner proposes to make the additions, modifications or deletions to the Work described in the Contract Documents as shown in Attachment "A". We request that you take the following action within 10 calendar days: Notify us that you concur that this change does not require a change in Contract time or amount. A Field Order will be issued. X Submit a Price/Credit Proposal with detailed cost breakdown of labor, materials, equipment and all other costs related to this change. Impacts on Contract Time shall be shown in a revised schedule, included with the submitted proposal. ❑ Proceed with the change. Payment will be made at the unit price bid. ❑ Proceed with the change under the time and materials provisions of the Contract. Authorization to proceed with changes must be approved by the Owner through Change Order in accordance with the Contract Documents. By: Brian Beach Date: 3/27/17 BUILDER'S RESPONSE: We respond to your request as follows: ❑ We propose that this is a no cost or time change. Issue Field Order. X We submit the attached Price/Credit Proposal with detailed cost breakdown and revised schedule for performing the described change. Il We are proceeding with the change at the unit price bid. ❑ We are proceeding with the change under the time and materials provisions of the Contract. By: George Craig Date: ACTION TAKEN: ❑ Proposed Contract Modification rejected. See comments. ❑ Field Order will be issued. X Change Order will be issued. By: Date: PROPOSED CONTRACT MODIFICATION ATTACHMENT A CSA CONSTRUCTION, INC. 2314 McAllister Road Houston, TX 77092 P: 713-686-8868/F: 713-689-8889 OWNER: City of Lubbock, Texas PROJECT: Improvments to the North & South WTP's ENGINEER: Alan Plummer CM: Freese & Nichols CONTRACTOR: CSA Construction, Inc. PREPARED BY: George Craig DATE: April 3, 2017 DESCRIPTION OF CHANGE: Delete colored split face veener at new disinfection building and replace with smooth face gray CMU veener. TAXABLE EXEMPT LABOR TOOLS & EQUIP MATERIAL DESCRIPTION QUANTITY UNIT TOTAL UNIT TOTAL UNIT TOTAL TOTAL Credit to change from colored split face to smooth face gray 1 Is - - (4,000.00) (4,000) (4,000) SUBTOTALS Clarifications 1. Includes changing all veneer walls from colored split face veener to smooth faced gray CMU. 2. No painting is included. A block sealer will still be applied per the approved sealer subimttal. 3. Mortar will be gray and not colored. 4. Control Joint caulking will be gray to match the gray block. (4,000) (4,000) (4,000) MFREESE ?NICHOLS PROPOSED CONTRACT MODIFICATION 4.41 / PROJECT: Improvements to the North and South WTPs II PROJECT NUMBER: OWNER: City of Lubbock 91032.9241.3000 BUILDER: C.S.A. 1603 ENGINEER: Freese & Nichols, Inc. LUB16498 DESCRIPTION: Additional Core Holes at South Plant PCM No: 003 NOTIFICATION TO BUILDER: The Owner proposes to make the additions, modifications or deletions to the Work described in the Contract Documents as shown in Attachment "A". We request that you take the following action within 10 calendar days: Notify us that you concur that this change does not require a change in Contract time or amount. A Field Order will be issued. X Submit a Price/Credit Proposal with detailed cost breakdown of labor, materials, equipment and all other costs related to this change. Impacts on Contract Time shall be shown in a revised schedule, included with the submitted proposal. Proceed with the change. Payment will be made at the unit price bid. Proceed with the change under the time and materials provisions of the Contract. Authorization to proceed with changes must be approved by the Owner through Change Order in accordance with the Contract Documents. By: Brian Beach Date: BUILDER'S RESPONSE: We respond to your request as follows: We propose that this is a no cost or time change. Issue Field Order. X We submit the attached Price/Credit Proposal with detailed cost breakdown and revised schedule for performing the described change. We are proceeding with the change at the unit price bid. We are proceeding with the change under the time and materials provisions of the Contract. By: CSA George Craiq Date: ACTION TAKEN: Proposed Contract Modification rejected. See comments. Field Order will be issued. X Change Order will be issued. By: Date: PROPOSED CONTRACT MODIFICATION ATTACHMENT A The Owner proposes to make the following additions, modifications or deletions to the work described in the Contract Documents. Authorization to proceed with these changes must be approved by Field Order or Change Order in accordance with the Contract Documents, prior to commencing the work involved. Contractor to provide 2 core holes with 3 link seal connections. 1 core drill will be located through the 2"d floor in the NaOCI chemical room on the second floor in the South plant. There will be 2 link seals for this drilled hole. The Contractor will provide a continuous 6" curb with #5 rebar 12" OCEW and#5 dowels @ 12" OC, 3" offset from the hole in the NaOCI chemical room floor. Contredon Con:etuaus mix+ale Gab wan nydlat r, walerstop SurfaOa roLig nless to "' aTpbo ae to whin I • of edge of epoxy bonding agent pnor to mrnGetc ptatenteni Robs. M5 ® 12'(see general ccncrelo notes) 1• PVC toe by -- city 1 tie tn•a�+ d apNagm valve by Coy t�NatlCVPVC �jl �:_. �_ E. by City s� 1 PVC clbnw by city - Centnctor Coro drill pipe penetration tough elab with two (2) kM seals Standard Dalai) 321. -- -- - y� Pack 2' ri n shemk grout on top or lop link seal The Second hole will be through the west wall of the chlorine dioxide feed room with 1 link seal. By: Byron Stickney Date: 10/27/2017 CSA CONSTRUCTION, INC. 2314 McAllister Road Houston, TX 77092 P: 713-686-8868/F: 713-689-8889 CS OWNER: City of Lubbock, Texas PROJECT: Improvments to the North & South WTP's ENGINEER: Alan Plummer CM: Freese & Nichols CONTRACTOR: CSA Construction, Inc. PREPARED BY: George Craig DATE: July 7, 2017 DESCRIPTION OF CHANGE: Core Drill & Concrete Work at South WTP per the provided sketches TAXABLE EXEMPT LABOR TOOLS & EQUIP MATERIAL DESCRIPTION QUANTITY UNIT TOTAL UNIT TOTAL UNIT TOTAL TOTAL Core Drilling & Associated Concrete work at South WTP 1 Is 2,940.00 2,940 2,336.00 2,336 1,165.00 1,165 6,441 SUBTOTALS Clarifications 1. Link Seal Materials Included 2. No pipe material or installation included. 3. Owner to confirm with CSA on final location of each cored hole. 4. CSA requests an additional 3 days. 5. No electrical work included 6. No painting of any kind included. 7. No wall sleeves included. 2,940 2,336 1,165 6,441 Tax 8.25 % 193 Subtotal 6,634 OH&P 15% 995 Total 7,629 Y _. ` i' Sr L' } 1" PVC 1 i ,. tee by t ' 1 - City p 1" true union - �'-'" diaphragm l valve by City ti 1" PVC elbow by 1/NaOCl/PVC Ci by city Contractor: Core drill pipe penetration through slab with two (2) link seals - Standard Detail 327, topped with non -shrink grout 77, i Contractor: Continuous concrete curb with ' hydrophilic waterstop. Surface roughness to %" amplitude to within 1" of edge of epoxy bonding agent prior to concrete placement - Rebar: #5 @ 12" (see general concrete notes) r r• Plan view of pipe penetration — not to scale Continuous concrete curb M #5 rebar @ 12" OCEW 1 (horizontal) and #5 dowels @ 12" 3" OC with 4" Link sealr4l� 1/NaOCl/PVC embedment (not shown) 6„ 3„ 11 p}T 311 6„ 3" M FREESE ?NICHOLS PROPOSED CONTRACT MODIFICATION 4.41 / PROJECT: Improvements to the North and South WTPs II PROJECT NUMBER: OWNER: City of Lubbock 91032.9241.3000 BUILDER: C.S.A. 1603 ENGINEER: Freese & Nichols, Inc. LUB16498 DESCRIPTION: Relocate Fiber Optic Cable in Existing Conduit PCM No: 004 NOTIFICATION TO BUILDER: The Owner proposes to make the additions, modifications or deletions to the Work described in the Contract Documents as shown in Attachment "A". We request that you take the following action within 10 calendar days: Notify us that you concur that this change does not require a change in Contract time or amount. A Field Order will be issued. X Submit a Price/Credit Proposal with detailed cost breakdown of labor, materials, equipment and all other costs related to this change. Impacts on Contract Time shall be shown in a revised schedule, included with the submitted proposal. Proceed with the change. Payment will be made at the unit price bid. Proceed with the change under the time and materials provisions of the Contract. Authorization to proceed with changes must be approved by the Owner through Change Order in accordance with the Contract Documents. By: Brian Beach Date: 3/27/17 BUILDER'S RESPONSE: We respond to your request as follows: We propose that this is a no cost or time change. Issue Field Order. X We submit the attached Price/Credit Proposal with detailed cost breakdown and revised schedule for performing the described change. We are proceeding with the change at the unit price bid. We are proceeding with the change under the time and materials provisions of the Contract. By: George Craig Date: ACTION TAKEN: Proposed Contract Modification rejected. See comments. Field Order will be issued. X Change Order will be issued. By: Date: PROPOSED CONTRACT MODIFICATION ATTACHMENT A The Owner proposes to make the following additions, modifications or deletions to the work described in the Contract Documents. Authorization to proceed with these changes must be approved by Field Order or Change Order in accordance with the Contract Documents, prior to commencing the work involved. Contractor will remove (2) existing fiber optic lines (1-12 fiber, 1-24 fiber) lines from current project defined conduit and pull (2) new fiber optic lines (1-12 fiber, 1-24 fiber) through abandoned conduit to make room for project defined power cables from EMH-04 to EMH-06. The (2) new fiber lines will be re -spliced to existing lines to ensure continued connection for City of Lubbock plant operations and maintenance staff. By: Byron Stickney Date: 3/28/2017 CSA CONSTRUCTION, INC. 2314 McAllister Road Houston, TX 77092 P: 713-686-8868/F: 713-689-8889 CS OWNER: City of Lubbock, Texas PROJECT: Improvments to the North & South WTP's ENGINEER: Alan Plummer CM: Freese & Nichols CONTRACTOR: CSA Construction, Inc. PREPARED BY: George Craig DATE: June 5, 2017 DESCRIPTION OF CHANGE: Relocate 2 existing fiber cables in existing ductbank to free up a 4" conduit that was shown to be a spare TAXABLE EXEMPT LABOR TOOLS & EQUIP MATERIAL DESCRIPTION QUANTITY UNIT TOTAL UNIT TOTAL UNIT TOTAL TOTAL SCI Work 1 Is - - 6,855.00 6,855 6,855 SUBTOTALS - - 6,855 6,855 OH&P 0% - Total 6,855 Clarifications SYSTEM CONTROLS & INSTRUMENTATION SUBMITTED TO: CSA System Control & Instrumentation 11218 IH-10 EAST, CONVERSE, TX 78109 210-661-9901 (Office) 210-666-5575 (Fax) PROPOSAL PROJECT NAME: Lubbock North WTP CONTACT: George PHONE: FAX: Change Order 002 Relocation of existing fiber for MCC-RM power feeder SCOPE OF WORK: We had to relocate (2) existing fiber cable in the ductback to free up the 4" conduit which was shown on the contract drawings as spare. TOTAL AMOUNT $6,855.52 Additional Days: 0 additional days are required for this work from the date of the signed Change Order and Notice to Proceed with this work is received, subject to availability of personnel when signed Change Order is received, to the extend personnel are unavailable, the time extension will/must be extended to the extent necessary to allow personnel availability for this work and arrival of the equipment and materials. EXCLUSIONS: 1. Sales tax. 2. Asphalt repairs to the road, removal and re -installing the fence to the manhole and all other exception as stated on the contract. 3. Any other materials or equipment not listed on this Proposal This Proposal may expire in 30 days or upon written retraction by SCI. If you have any questions regarding this Proposal, please give me a call. SUBMITTED BY: System Control & Instrumentation, Ltc Michael Jarrett 6/4/2017 Project Manager Date System Controls & Instrumentation, Ltd. PAGE 1 Description Ref Ref Amount Op Rate Amount Material Material Total= See Attachment $2,305.04 x 1.00 2305.04 Shipping Costs 0.00 Subtotal 2305.04 Direct Labor Project Manager Per Hour 0.00 x 75.00 0.00 Superintendent Per Hour 3.54 x 65.00 229.91 Electrician Per Hour 8.37 x 55.00 460.35 Instrument tech Per Hour 27.00 x 55.00 1485.00 Labor Adjustment, Elevated Work 10'-20' 0.00 Programmer Per Hour 0.00 x 85.00 0.00 Estimator Per Hour 0.00 x 60.00 0.00 Subtotal 2175.26 Indirect Labor Submittals & O&M Manuals Calc 0.00 x 33.00 0.00 Testing Calc 0.00 x 45.00 0.00 Training Calc 0.00 x 45.00 0.00 Drawings Calc 0.00 x 33.00 0.00 Purchase Agent Calc 0.00 x 40.00 0.00 Procurement Calc 0.00 x 20.00 0.00 Subtotal 0.00 Labor Burden Percent 2175.26 % 45.00 978.86 Travel Lodging Per Day 0.00 x 75.00 0.00 Meals Per Day 1.00 x 30.00 30.00 Subtotal 30.00 Equipment Equipment Rental See Attahment Tools Labor Total 3154.12 % 3.00 94.62 Expendable Material Total 2305.04 % 3.00 69.15 Procrement Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Electrician/Super/Tech Vechicle 60.00 Per Day 1.00 x 60.00 60.00 Programmer Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Subtotal 223.77 Subtotal Liability/Builters Risk Insurance + Bond 5712.93 % 0.00 0.00 5712.93 Job total OVERHEAD & PROFIT Job Subtotal 5712.93 % 20.00 1142.59 $6,855.52 SUBCONTRACTOR 0.00 % 5.00 0.00 $0.00 BOND 6855.52 % 0.00 0.00 BID TOTAL $6,855.52 System Controls & Instrumentation 112181H-10 E. Converse, TX Page 2 Item Material Vendor/Units CITY Unit Material AdJ Material Extended Labor Unit Labo AdJ Labor Extended fiber outdoors lice enclosure 4 $94.95 1.00 $379.80 0.5000 1.00 2.0000 12 strand fiber cable 650 $0.9965 1.00 $647.73 0.0047 1.00 3.0550 24 strand fiber cable 650 $1.9654 1.00 $1,277.51 0.0051 1.00 3.3160 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.00001 1.00 1 0.0000 $0.00 Total Materials: 1.00 $0.00 $2,305.04 1 0.00001 1.00 Total Labor. 0.0000 8.3700 FFREESE M'<'NICHOLS PROPOSED CONTRACT MODIFICATION 4.41 / PROJECT: Improvements to the North and South WTPs II PROJECT NUMBER: OWNER: City of Lubbock 91032.9241.3000 BUILDER: C.S.A. 1603 ENGINEER: Freese & Nichols, Inc. LUB16498 DESCRIPTION: Control Room Power Feed PCM No: 006 NOTIFICATION TO BUILDER: The Owner proposes to make the additions, modifications or deletions to the Work described in the Contract Documents as shown in Attachment "A". We request that you take the following action within 10 calendar days: ❑ Notify us that you concur that this change does not require a change in Contract time or amount. A Field Order will be issued. X Submit a Price/Credit Proposal with detailed cost breakdown of labor, materials, equipment and all other costs related to this change. Impacts on Contract Time shall be shown in a revised schedule, included with the submitted proposal. ❑ Proceed with the change. Payment will be made at the unit price bid. ❑ Proceed with the change under the time and materials provisions of the Contract. Authorization to proceed with changes must be approved by the Owner through Change Order in accordance with the Contract Documents. By: Byron Stickney Date: 8/15/2017 BUILDER'S RESPONSE: We respond to your request as follows: ❑ We propose that this is a no cost or time change. Issue Field Order. X We submit the attached Price/Credit Proposal with detailed cost breakdown and revised schedule for performing the described change. ❑ We are proceeding with the change at the unit price bid. ❑ We are proceeding with the change under the time and materials provisions of the Contract. By: CSA George Craig Date: ACTION TAKEN: ❑ Proposed Contract Modification rejected. See comments. ❑ Field Order will be issued. X Change Order will be issued. By: Date: PROPOSED CONTRACT MODIFICATION ATTACHMENT A The Owner proposes to make the following additions, modifications or deletions to the work described in the Contract Documents. Authorization to proceed with these changes must be approved by Field Order or Change Order in accordance with the Contract Documents, prior to commencing the work involved. Option 1 — Restore the system to current level: Adjust the trip setting of the switchgear breaker from "400 amp" to "600 amp". Provide a tap box (Tap Box 4) in the Pump House Pipe Gallery. In lieu of providing one set of 3#500MCM conductors from the main electrical switchgear to the MCC, provide two sets of 3#350MCM from main electrical switchgear to Tap Box 4. Terminate the new conductors to the existing conductors at Tap Box 4. The existing conductors were installed in the Phase I Improvements. The tap at the control room MCC will remain. Option 2 — Remove the tap at the Control Room MCC: Adjust the trip setting of the switchgear breaker from "400 amp" to "600 amp". Provide a tap box (Tap Box 4) in the Pump House Pipe Gallery. In lieu of providing one set of 3#500MCM conductors from the main electrical switchgear to the MCC, provide two sets of 3#350MCM from main electrical switchgear to Tap Box 4. Terminate the new conductors to the existing conductors at Tap Box 4. The existing conductors were installed in the Phase I Improvements. Install a 350 amp breaker in the Control Room MCC. Re -utilizing the feed from Tap Box 3 to the Power Panel, feed the power panel from the MCC. By: Byron Stickney Date: 8/15/2017 RFI RESPONSE ASSOCIATES, INC. LW1kL ENVIRONMENTAL ENGINEERS • DESONERS • SCIENTISTS RESPONSE - RFI-22, CONTROL ROOM MCC:CR NEW POWER FEED Question: We need the below items address for the Control Room MCC-CR new power feed. I. In spec 01105 "SEQUENCE OF CONSTRUCTION" 1.4 B. j. it is calling for us to remove the last two feeders feeding the existing pump house switch board from the existing switchgear. If we remove both feeders, this will de -energize the control room's MCC:CR. We understand the remaining feeders to the existing pump house switch board will need to be removed so we can re -use one of the existing conduits for the new power feed to MCC:CR. To minimize power outage we propose to remove only one of the feeders from the existing pump house switch boards to keep the MCC.CR energized until we are able to pull the new power feed. Once this is complete then we can schedule to shut down the control room's MCC:CR. Is this acceptable and will one set of 3-350mcm be enough amperage for control room MCC:CR? 2. When looking into how the keep MCC:CR energized until we are able to install the new power feed we found the following. One of the existing power feed sets has been tapped in the gutter located in the pipe gallery, just outside of the control room. We believe this power tap is to feed the 480VAC panel `J' in the control room. We will need a directive on how to refeed both the MCC:CR and panel `J'. a. Do we tap the new feed in the gutter as it is currently installed? b. Is there room to add a breaker in MCC:CR to add a breaker to feed Panel VT This will also give a means of disconnecting power to panel ` , without disconnecting power to MCC:CR. c. Other options? Response: Please refer to ATTACHMENT 1-RFI22 for additional details. The "as design" one line diagram has a single set of 3#500MCM conductors being installed from the main electrical building switchgear to the control room MCC. The conductors were sized for the load in the MCC. As explained in the RFI, there is a tap made on the incoming conductors to feed the 480V panel for the control room. The tap is located in the filter gallery before the conductors enter the MCC. The single set of 3#500MCM conductors cannot carry the load of both the panel board and the MCC. Option 1 — Restore the system to current level: • Adjust the trip setting of the switchgear breaker from "400 amp" to "600 amp". • Provide a tap box (Tap Box 4) in the Pump House Pipe Gallery. • In lieu of providing one set of 3#500MCM conductors from the main electrical switchgear to the MCC, provide two sets of 3#350MCM from main electrical switchgear to Tap Box 4. • Terminate the new conductors to the existing conductors at Tap Box 4. The existing conductors were installed in the Phase I Improvements. • The tap at the control room MCC will remain. Page 1 of 2 RPI-22 RESPONSE Option 2 — Remove the tap at the Control Room MCC: • Adjust the trip setting of the switchgear breaker from "400 amp" to "600 amp". • Provide a tap box (Tap Box 4) in the Pump House Pipe Gallery. • In lieu of providing one set of 3#500MCM conductors from the main electrical switchgear to the MCC, provide two sets of 3#350MCM from main electrical switchgear to Tap Box 4. • Terminate the new conductors to the existing conductors at Tap Box 4. The existing conductors were installed in the Phase I Improvements. • Install a 350 amp breaker in the Control Room MCC. • Re -utilizing the feed from Tap Box 3 to the Power Panel, feed the power panel from the MCC. Page 2 of 2 D (A .0 N m CONTROL ROOM (n MCCCR C) z D N 0 m CONTROL ROOM (n POWER PANEL C) z 1-1 CHEMICAL\�\�\\\\\\�\\\�.��\\\�i BUILDING m MCC:CB� �J°�� x CONTROL ROOM 3 500MCMt1 OC, 4' C. Ry� �S N Ma.'CR Si � 0 @@ Gn 0 CONTROL ROOM POWER PANEL �O z CONTROL ROOM MCC.'CR 0 CONTROL ROOM 0 POWER PANEL 0 3/350MCMt7/OG, 3' N 1CONTROL ROOM 1 SETS OF 3/350MCM+2/OO, 3' C. CHEMICAL BUILDING MCC:CB 7 SETS OF 3/350MCM42/00, 3' C. 2 SETS OF 3j350MCM,2/0G, 3' C: Q D;a n� _;u ZO . Z N TT m N CSA CONSTRUCTION, INC. 2314 McAllister Road Houston, TX 77092 P: 713-686-8868/F: 713-689-8889 c5D OWNER: City of Lubbock, Texas PROJECT: Improvments to the North & South WTP's ENGINEER: Alan Plummer CM: Freese & Nichols CONTRACTOR: CSA Construction, Inc. PREPARED BY: George Craig DATE: September 1, 2017 DESCRIPTION OF CHANGE: Option # 2 Remove the Tap at the Control room MCC, per PCM 006 TAXABLE EXEMPT LABOR TOOLS & EQUIP MATERIAL DESCRIPTION QUANTITY UNIT TOTAL UNIT TOTAL UNIT TOTAL TOTAL Cost from SCI for Option # 2 1 Is - - - - 20,547.00 20,547 20,547 SUBTOTALS - - 20,547 20,547 Tax 8.25 % - Subtotal 20,547 OH&P 15% 3,082 Total 23,629 Clarifications 1. CSA requests an additional 5 days C-�i;o System Control & Instrumentation 5404 FM 1044 New Braunfels, Texas 78130 SYSTEM CONTROLS&INSTRUMENTATION 830-420-3392 (Office) 830-420-3395 (Fax) PROPOSAL SUBMITTED TO: CSA PROJECT NAME: Lubbock North WTP CONTACT: George PHONE: FAX: Change Order 002 Power feed to MCC-CR per PCM #006 Option 2 SCOPE OF WORK: BASED ON PCM #006 OPTION 2 TOTAL AMOUNT $20,547.54 Additional Days: 05 additional days are required for this work from the date of the signed Change Order and Notice to Proceed with this work is received, subject to availability of personnel when signed Change Order is received, to the extend personnel are unavailable, the time extension will/must be extended to the extent necessary to allow personnel availability for this work and arrival of the equipment and materials. EXCLUSIONS: 1. Sales tax. 2. Asphalt repairs to the road, removal and re -installing the fence to the manhole and all other exception as stated on the contract. 3. Any other materials or equipment not listed on this Proposal This Proposal may expire in 30 days or upon written retraction by SCI. If you have any questions regarding this Proposal, please give me a call. SUBMITTED BY: System Control & Instrumentation, Ltc Michael Jarrett 9/1/2017 Project Manager Date System Controls & Instrumentation, Ltd. PAGE 1 Description Ref Ref Amount Op Rate Amount Material Material Total= See Attachment $8,876.70 x 1.00 8876.70 Shipping Costs 0.00 Subtotal 8876.70 Direct Labor Project Manager Per Hour 0.00 x 75.00 0.00 Superintendent Per Hour 8.69 x 65.00 564.72 Electrician Per Hour 86.88 x 55.00 4778.40 Instrument tech Per Hour 0.00 x 55.00 0.00 Labor -Adjustment, Elevated Work 10'-20' 0.00 Programmer Per Hour 0.00 x 85.00 0.00 Estimator Per Hour 0.00 x 60.00 0.00 Subtotal 5343.12 Indirect Labor Submittals & O&M Manuals Calc 0.00 x 33.00 0.00 Testing Calc 0.00 x 45.00 0.00 Training Calc 0.00 x 45.00 0.00 Drawings Calc 0.00 x 33.00 0.00 Purchase Agent Calc 0.00 x 40.00 0.00 Procurement Calc 0.00 x 20.00 0.00 Subtotal 0.00 Labor Burden Percent 5343.12 % 45.00 2404.40 Travel Lodging Per Day 0.00 x 75.00 0.00 Meals Per Day 0.00 x 30.00 0.00 Subtotal 0.00 Equipment Equipment Rental See Attahment Tools Labor Total 7747.52 % 3.00 232.43 Expendable Material Total 8876.70 % 3.00 266.30 Procrement Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Electrician/Super/Tech Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Programmer Vechicle 60.00 Per Day 0.00 x 60.00 0.00 Subtotal 498.73 Subtotal Liability/Builters Risk Insurance + Bond 17122.95 % 0.00 0.00 17122.95 Job total OVERHEAD & PROFIT Job Subtotal 17122.95 % 20.00 3424.59 $20,547.54 SUBCONTRACTOR 0.00 % 5.00 0.00 $0.00 BOND 20547.54 % 0.00 0.00 BID TOTAL $20,547 54 System Controls & Instrumentation 112181H-10 E. Converse, TX Page 2 Item Vendor/Units QTY Material Unit Material AdJ Material Extended Labor Unit Labo I AdJ Labor Extended 350MCM ft 1650 $7.75 1.00 $12,787.50 0.0000 1,00 0.0000 350MCM ft 1650 $7.75 1.00 $12,787.50 0.0420 1.00 69.3000 TAP BOX EA 1 $504.00 1.00 $504.00 1.0000 1.00 1.0000 TAP KITS EA 8 $25.00 1.00 $200.00 0.3000 1.00 2.4000 350 AMP BREAKER FOR MCC-CR EA 1 $4.700.00 1.00 $4.700.00 6.0000 1.00 6.0000 3" ALUM CONDUIT FT 10 $17.87 1.00 $178.70 0.0865 1.00 0.8650 3" ALUM 90s EA 2 $186.00 1.00 $372.00 0.3250 1.00 0.6500 3" ALUM LL FITTING EA 1 $171.00 1.00 $171.00 0.3250 1.00 0.3250 3" ALUM COUPLING EA 4 $48.00 1.00 $192.00 0.0850 1.00 0.3400 REMOVE AND REPULL CABLE TO POWER PANEL EA 1 $0.00 1.00 $0.00 6.0006 1.00 6.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 500MCM ft -2100 $10.96 1.00 $23,016.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 1 0.0000 1.00 0.0000 $0.00 1.00 $0.00 1 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 1.00 $0.00 0.0000 1.00 0.0000 $0.00 Total Materials: 1.00 $0.00 $8,876.70 0.0000 1.00 Total Labor. 0.0000 86.8800 FREESE F 2 1NICHOLSS PROPOSED CONTRACT MODIFICATION 4.41 / PROJECT: Improvements to the North and South WTPs II PROJECT NUMBER: OWNER: City of Lubbock 91032.9241.3000 BUILDER: C.S.A. 1603 ENGINEER: Freese & Nichols, Inc. LUB16498 DESCRIPTION: Additional FCA's for South Plant Piping PCM No: 008 NOTIFICATION TO BUILDER: The Owner proposes to make the additions, modifications or deletions to the Work described in the Contract Documents as shown in Attachment "A". We request that you take the following action within 10 calendar days: Notify us that you concur that this change does not require a change in Contract time or amount. A Field Order will be issued. X Submit a Price/Credit Proposal with detailed cost breakdown of labor, materials, equipment and all other costs related to this change. Impacts on Contract Time shall be shown in a revised schedule, included with the submitted proposal. Proceed with the change. Payment will be made at the unit price bid. Proceed with the change under the time and materials provisions of the Contract. Authorization to proceed with changes must be approved by the Owner through Change Order in accordance with the Contract Documents. By: Brian Beach Date: BUILDER'S RESPONSE: We respond to your request as follows: We propose that this is a no cost or time change. Issue Field Order. X We submit the attached Price/Credit Proposal with detailed cost breakdown and revised schedule for performing the described change. We are proceeding with the change at the unit price bid. We are proceeding with the change under the time and materials provisions of the Contract. By: CSA George Craig Date: ACTION TAKEN: Proposed Contract Modification rejected. See comments. Field Order will be issued. X Change Order will be issued. By: Date: PROPOSED CONTRACT MODIFICATION ATTACHMENT A The Owner proposes to make the following additions, modifications or deletions to the work described in the Contract Documents. Authorization to proceed with these changes must be approved by Field Order or Change Order in accordance with the Contract Documents, prior to commencing the work involved. Contractor to add 2 additional FCA couplings to south plant piping to provide proper connection to existing welded piping. ADD FCXS jW d By: Byron Stickney Date: 10/17/2017 CSA CONSTRUCTION, INC. 2314 McAllister Road Houston, TX 77092 P: 713-686-8868/F: 713-689-8889 CSD OWNER: City of Lubbock, Texas PROJECT: Improvments to the North & South WTP's ENGINEER: Alan Plummer CM: Freese & Nichols CONTRACTOR: CSA Construction, Inc. PREPARED BY: George Craig DATE: October 10, 2017 DESCRIPTION OF CHANGE: Install two 16 FCA's at sheet C-810 to adapt the existing steel pipe to the new ductile iron tee. Reference SD-082 TAXABLE EXEMPT LABOR TOOLS & EQUIP MATERIAL DESCRIPTION QUANTITY UNIT TOTAL UNIT TOTAL UNIT TOTAL TOTAL Purchase FCA's-Cohen 1 Is - - 2,602.00 2,602 2,602 Installation-CSA 2 ea 300.00 600 100.00 200 - 800 SUBTOTALS 600 200 2,602 3,402 Tax 8.25 % 17 Labor Burden 30% 180 Subtotal 3,599 P 15% 540 Total 4,138 ON SITE PHONE N... Your Yard REQUIRED SHIP DATE 10/3/2017 CSA Construction, Inc. 2314 McALLISTER ROAD HOUSTON, TX 77092 5817286 Order Date 10/3/2017 LUBBOCK N WTP 6001 NORTH GUAVA LUBBOCK, TX 79403 KEVIN 713-204-0643 1603-18 2016-210 IMPROVEMENTS TO IN... BC Net 30 COHEN TRUCK Ordered Shipped Part Nu... Description *ADDED FCA'S FOR EXT 16" STEEL PIPE -PLEASE SHIP DIRECT 2 3528-16 16" 3528 FLGD COUPLING ADAPTER 17.626 OD X 16" FLANGE - FABRICATED FCA P *PER SHEET C-810 & 2016-210-M5 *ADDED- FCA'S NEEDED FOR TIE IN AT EXISTING STEEL PIPE Tag Num... Rate WT. 1001.1 1,301.23 Any and all errors or shortages with shipments must be reported within five (5) days of receipt of shipment. CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2017-292414 CSA Construction, Inc. Houston, TX United States Date Filed: 12/11/2017 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 12/11/2017 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 16-12943-TF Improvements to the North and South Water Treatment Plants Change Order #1 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Austin, Rich Chappell Hill, TX United States X Mayfield, Richard Cypress, TX United States X Craig, George Houston, TX United States X Schultz, Kenneth Houston, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337 CERTIFICATE OF INTERESTED PARTIES Complete Nos. 1- 4 and 6 If there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties- 2 Name of business entity filing form, and the city, state and country of the business entity's place of business. CSA Construction, Inc. Houston, TX United States Name of govemmental entity or state agency that is a party to the contract for Mich the rorm Is being fit". City of Lubbock FORM 1295 iof1 OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number. 2017-292414 Date Filed: 12/il/2017 Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 16-12943-TF Improvements to the North and South Water Treatment Plants Change Order #1 4 Name of Interested Party City, State, Country (place of business) ture of Interest (heck applicable) Controlling Intermediary Austin, Rich Chappell Hill, TX United States X Mayfield, Richard Cypress, TX United States X Craig, George Houston, TX United States X Schultz, Kenneth Houston, TX United States X C r6nwL nab• i1 N.-- I &IA I ........ I - ------ -- -- ----- -- ...__._____ . '-- . Li 6 AFFIDAVIT I swear, or rm, er p ty of perjury, that the above disclosure is true and correct MARJORY ELIZ 130H SANDERS • My Notary ID# 126620389 Expires August 29, 2020 �� • Rich A tin Si re of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _ Fme dgp this the _ 11 rh _ day of ber 20 17 to cerfify which, witness my hand and seal of office. [) of Ricer pads ministering on Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337