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eitp of Miami
Project Name: Fire Station No.4 Re -Roofing
Contractor: Florida Roofing Solutions
Contract Award Date:
Revised Completion Date (prior to this change): Jun-06
Revised Completion Date (including this change): Jun-06
Contract Change Order
Project Number:
Change Order No.:
Completion Date:
Extensions of Time
Previously Approved:
The Contractor and the City hereby agree to modify the Contract of follows: (Attach additional pages as necessary).
B-72802
1
Jun-06
0 Days
Contract Price
Contract Time
Item
No.
Quantity
. Description
Unit
Price
Increase
Decrease
Increase
Decease
1
1
Stormwater Piping
3150
3150
F
1
S 3,150.00
$ -
0
0
SUMMARY OF CONTRACT AMOUNT
Reason for Change
Regulatory Change
City Requested
Design Error
Un fors een/Un forseeable
Original Contract Amount S
Cost of Construction Changes Previously Ordered $
X Adjusted Contract Amount Prior to this Change S
Cost of Construction Changes in this Change Order $
Adjusted Contract Amount Including Change S
Percentage Increase this Change Order 1.78%
Total Percent Increase to Date 1.78%
Contingency Funds Used OY ON Contingency S Contingency Balance
Extension of Time Allowed by this Change 0 Days
This change order is hereby incorporated into and becomes a pan of the Contract Documents.
Accepted By Contractor.
Accepted By CIP Director
Distribution: Contractor U A/E U Finance U Project File U
•
CIP Form 101
177,000.00
177,000.00
3,150.00
180,150.00
Date: PC ►` aptyl
Date:
(3,150.00)
Capital Improvements Transportation
444 SW 2nd Ave., 8th Floor
Miami, Florida 33130
Page 1 of 1
City of Miami
Capital Improvements & Transportation
Change Proposal Request
, PartA
CONTRACTOR: Florida Roofing Solutions, Inc.
ADDRESS: 4980 East 10th Court
Hialeah, Florida 33013
CHANGE ORDER NUMBER: 1
PROJECT NO.: B-72802
PROJECT TITLE: Fire Station No.4
Project Manager: Edwin Gaitan Tel. No.: 305.687.9877 Fax No.: 305.687.9876 E-mail:
This Change Proposal Request (CPR) is submitted requesting a Change Order to the Contract to
increase/decrease the time for performance or the value of the Contract
Detailed Basis/Scope for CPR (Failure to submit sufficient detail may result in the rejection of or delay in review of the
CPR)
Add drainage piping for stormwater runoff from roof.
Financial Data
Original Contract Value: $177,000
Value of Previous Change Orders: 0
CPR Value:$3,150
Proposed Contract Value: $180,150
Increase/Decrease in time for Completion: 0 (calendar days)
Current Completion Date: June 2006 Proposed Completion Date: June 2006
By signing and submitting this CPR the Contractor certifies that the supporting cost data is accurate and, in the
opinion of the undersigned, the stated prices and/or time request are both fair and reasonable. The signatory
certifies that they are authorized by the Contractor to execute this CPR.
Name: Edwin Gaitan
Title: President
Signatur
Date of Submi
:.a,,
City of Miami Review (Contractor not to complete)
By signing below the signatory has either concurred with or rejected the proposed CPR as submitted:
Architect/Engineer:
Name of Firm:
Name
City of Miami
Project Manager ❑ Concur ❑ Rejected
Name
Team Leader: ❑ Concur
Signature Date
Signature
❑ Rejected
Date
Name Signature Date
Assistant Director: ❑ Concur ❑ Rejected
Name
CIP Form 102A
Signature Date