Planned & Engineered Construction ~ A4321-4 9E0
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PROJECT TITLE: FY 2003-04 Storm Drain Rehabilitation Program SD03-09 CITY OFTIGARD
CONTRACTOR: Planned and Engineered Construction OREGON
3400 Centennial Drive, PO Box 5535
Helena, MT'59604
CHANGE ORDER NO. 1
The above identified contract is hereby changed as follows:
The following amount is to be added to the contract amount:seven thousand one hundred thirty-one dollars&fifty cents
TIME OF COMPLETION:
Contract completion date is hereby changed to read no change
CONTRACT SUMMARY
Original Contract Sum: $62,830.00 Previous Total: $62,830.00
Previous Addition: $0.00 This Change (Add:): $7,131.50
Total: $62,830.00
(Deduct:): $0.00
Previous Deductions: $0.00 NEW TOTAL: $69,961.50
CONTRACTOR -
Date: By.
By:
CITY OF TIGARD
Date: `� �—�� By.
By:
I:\ENG\2003-2004 FY CIP\Storm Drain Rehabilitation Program\change order 1 PandEC 6-3-04.xls
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 TDD (503)684-2772
CITY OF TIGARD
CONTRACT SUMMARY FORM
(THIS MUST ACCOMPANY EACH CONTRACT BEFORE AUTHORIZATION SIGNATURE CAN BE ACQUIRED)
Title of Contract:FY 2003-04 Storm Drain Pipe Rehabilitation Contract #:A4321-4q..,
Program, Cured-in-Place CEP SD 03-09
Contractor: Planned and Engineered Construction, Inc. Total: $ 69,961.50 , ,,;::,;,
Brief Overview: Request to increase PO amount b $7,131.50 'per attached change order no.l.
Changes Made To n/a
Boilerplate `
Contract:
Type of Contract: ❑ Purchase Agreement ❑ Personal Service ® Construction ❑ Other
Start Date:May I End Date:June 7, 2004 LCRB Award Date:3/23/04
Contract Manager:Vannie Nguyen Extension:2460 Department: Engineering
Quotes/Bids/Proposals: COMPANY AMOUNT/SCORE
Department Comments:
Department Si ature LlYhVVI Date: p
Purchasing Comments:
Purchasing Signa Date: G/a /Q 6
Administration: Date:
Certificate of Insurance Received? ®Yes ❑ No ❑ Self-Insured (Form Received)
Business Tax Current? ® Yes ❑ No Contractor License Current? ® Yes ❑ No
Federal TIN/1099 #: Bonds Required: ® Yes ❑ No
Accounting String: Fund Division Account Total
510 6250 752.013 $7,131.50
Total $69,961.50