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2021/05/17 L.C. Paving and Sealing, Inc. CIP 20-12 Order No. 001Page 1 of 2 DATE:5/17/2021 PROJECT DESCRIPTION: PROJECT NO:CIP 20-12 PURCHASE ORDER NO: CONTRACTOR:L.C. PAVING & SEALING, INC DESCRIPTION OF CHANGES AND/OR EXTRA WORK: The Contractor is hereby directed to make the herein described changes from the plans and specifications and/or perform the following described work not included in the Plans and Specifications for this project. ITEM DESCRIPTION U/M QUANTITY UNIT PRICE TOTAL 1 LS 1 $10,921.50 $10,921.50 2 LS 1 $5,260.00 $5,260.00 TOTAL ESTIMATED PRICE FOR THIS CHANGE ORDER:$16,181.50 JUSTIFICATION: (Be specific on each item. Attach supporting documents as necessary) CONTRACT CHANGE ORDER NO. 001 CITY OF MENIFEE DEPARTMENT OF PUBLIC WORKS THIS IS AN ADDED ITEM TO THE CONTRACT PER THE REQUEST OF EMWD FOR WHICH THEY WILL REIMBURSE THE CITY. THIS WORK INCLUDED THE FOLLOWING: 1) RELOATION OF WATER METERS 2) ADJUST WATER METER TO GRADE 3) ADJUST MANHOLE TO GRADE 4) ADJUST WATER VALVE/CLEANOUT TO GRADE. THIS CHANGE ORDER WILL COMPENSATE THE CONTRACTOR FOR BEING REQUIRED TO EXCEED WORK AS DESCRIBED IN BID SCHEDULE #2. ADAMS AVE STREET IMPROVEMENTS PHASE 2 THE CONTRACTOR HAD TO RFEMOVE TREES THAT WERE IN CONFLICT SEVERAL RESIDENTIAL ITEMS WHICH WERE ONLY DISCOVERED DURING UTILITY EXCAVATION, RELOCATIONS OF GATES, AND INSTALLING DRIVE WAY APPROACHES. ITEM #2 - THE CONTRACTOR HAD TO REMOVE SOME TREES IN ORDER TO PERFORM THE CONTRACT WORK. . THE TREES WERE REMOVED FOR THE FLOLLOWING REASONS. 1) DRIVEWAY APPROACHES LED RIGHT INTO TREES ON RESIDENCE PROPERTY 2) AFTER CUTTING THE ROOTS OF TREES THE TREES WERE GOING TO DIE. FOR THIS REASON THE TREES HAD TO BE REMOVED TO AVOID A PUBLIC SAFTEY HAZARDOUS SITUATION. 3) GATES AND FENCES WERE RELOCATED NECESSITATING THE REMOVAL OF TREES 4) THE RELOCATION OF UTILITES REQUIRED THE REMOAL OF TREES. This document shall become an amendment to the Contract and all provisions of the Contract will apply hereto. This Change Order constitutes a complete and final resolution of all claims of the Contract for additional time or additional compensation related to or affected by work that is the subject of this Change Order. Quantities of items other than Lump Sum are not to exceed the amounts indicated. ITEM #1 - EMWD ENTERNED INTO A REIMBURSEMENT AGREEMENT WITH THE CITY TO HAVE THE CONTRACTOR PERFORM VARIOUS ADJUSTMENTS TO THEIR WATER METERS. THIS INCLUDED THE RELOCATION OF WATER METERS, ADJUSTING WATER METERS TO GRADE, ADJUSTING MANHOLES, WATER VALVES, AND CLEANOUTS TO GRADE.THIS WORK WOULD HAVE NORMALLY BEEN PERFORMED BY EMWD PRIOR TO THE PROJECT STARTING HOWEVER EMWD WAS NOT ABLE TO ATTENED TO IT. THE CONTRACTOR WAS REQUIRED TO PERFORM WORK EXCEEDING BID SCHEDULE #2. THE CITY WILL BE REIMBURSED FOR ALL WORK REQURIED FOR BID SCHEDULE #2. M:\Public Works Department\_Public Works Projects\CIP Projects\20-12 Adams Street Improvements Ph 2\C- Construction\C-8 Change Orders (CCO) & Supporting Docs\CO#1\ADAMS AVE ST IMP PH 2 CO1 02884 DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F CONTRACT CHANGE ORDER NO. 001 CITY OF MENIFEE DEPARTMENT OF PUBLIC WORKS Page 2 of 2 CONTRACT VARIANCE SUMMARY CCO #Amount % 1 $16,181.50 1.97% Totals $16,181.50 1.97% $821,463.20 January 11, 2021 $0.00 March 16, 2021 $16,181.50 0 $837,644.70 March 16, 2021 AUTHORIZATION BY CITY: Recommended for approval by: ate: __________Date: __________ Approved by: Date: __________Date: __________ Armando G. Villa City Manager ACCEPTANCE BY CONTRACTOR: We, the undersigned Contractor, have given careful consideration to the above described changes and/or extra work and hereby agree that said work is a supplement to the contract and all provisions will apply hereto. Accepted by: _____________________________________________________ Date: ____________________________ Signature _____________________________________________________ Please print name and title Don Sharp, Construction Manager Yolanda Macalalad Interim City Engineer, PE __________________________________________D Diego Guillen, Associate Engineer, PE __ ____________________________________________________________________________________ 0 No additional Working Days will be required to perform this work. Description Revised Contract Amount: Original Contract Amount: 0 Date Approved Current Change Order Amount: Previous Change Order Amounts: Date Started: Original Completion Date: Additional Time Additional Time (Working Days) Revised Completion Date: TO PERFORM WATER METER WORK FOR EMWD / REMOVAL OF TREES M:\Public Works Department\_Public Works Projects\CIP Projects\20-12 Adams Street Improvements Ph 2\C- Construction\C-8 Change Orders (CCO) & Supporting Docs\CO#1\ADAMS AVE ST IMP PH 2 CO1 ________________________________ DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F Nicholas Haas 5/18/2021 Project Manager 5/19/20215/19/2021 5/19/2021 5/20/2021 DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 TO OWNER:Project: Adams Ave Street Improvements APPLICATION NO:1-EMWD Distribution to: ATTN: City of Menifee X OWNER 29844 Haun Rd.ARCHITECT Menifee, Ca 92586 PERIOD TO: 03/31/2021 CONTRACTOR FROM CONTRACTOR: LC Paving & Sealing Inc. 620 Alpine Way PROJECT NOS: Escondido, CA 92029 CONTRACT FOR:CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract.information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached.completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $37,558.00 2. Net change by Change Orders $10,921.50 CONTRACTOR: LC Paving & Sealing Inc. 3. CONTRACT SUM TO DATE (Line 1 ± 2) $$48,479.50 4. TOTAL COMPLETED & STORED TO $48,479.50 DATE (Column G on G703)By:Nicholas Haas Date: 05/17/2021 5. RETAINAGE: a.5 % of Completed Work $$2,423.98 (Column D + E on G703) b.% of Stored Material $Included in above (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) $48,479.50 6. TOTAL EARNED LESS RETAINAGE $46,055.52 (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) $0 8. CURRENT PAYMENT DUE $46,055.52 9. BALANCE TO FINISH, INCLUDING RETAINAGE $2,423.98 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month $10,921.50 TOTALS This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without NET CHANGES by Change Order prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 · APPLICATION AND CERTIFICATION FOR PAYMENT · 1992 EDITION · AIA · ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee. $10,921.50 DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:1-EMWD Contractor's signed certification is attached.APPLICATION DATE:5/17/21 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:3/31/21 Use Column I on Contracts where variable retainage for line items may apply.ARCHITECT'S PROJECT NO:N/A A B C D E F G H I J ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGE NO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C - G)RATE) (D + E)(NOT IN TO DATE D OR E)(D+E+F) 1 Relocation of Water Meters $31,250.00 $0.00 $44,613.00 $0.00 $44,613.00 142.76%($13,363.00)$0.00 2 Adjust Water Meter to Grade $4,658.00 $0.00 $2,216.50 $0.00 $2,216.50 47.58%$2,441.50 $0.00 3 Adjust Manhole to Grade $1,350.00 $0.00 $1,350.00 $0.00 $1,350.00 100.00%$0.00 $0.00 4 Adjust Water Valve/Cleanout to Grade $300.00 $0.00 $300.00 $0.00 $300.00 100.00%$0.00 $0.00 GRAND TOTALS $37,558.00 $0.00 $48,479.50 $0.00 $48,479.50 ($10,921.50)$0.00 DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F Invoice Invoice No:19465 L.C. Paving & Sealing, Inc.Date:17-May-21 620 Alpine Way LCP Job No:15396 Escondido, CA 92029 nick@lcpaving.com P. (760) 752-1743 F. (760-752-1674 To:Job Information: City of Menifee Adams Ave. 29844 Haun Rd.Street Improvements Menifee, Ca 92586 *EMWD* No. 01 Terms: Item Quantity Description Rate Price 1 1 As Per Attached Application for Payment $46,055.52 March AIA EMWD No. 01 Retention Held (See Pay App) $2,423.98 Total:$46,055.52 Thank you for your business! DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F DocuSign Envelope ID: 285EA683-494E-4E60-836F-37FAC5663D8F