HomeMy WebLinkAboutResolutions - R-11-018 - 08/29/2011 - IDOT MFT ENGINEERING FOR 2005 STREET PROGRAM 15 3Illinois Department
n
of Trasportation
Date: 8/29/2011
Request No. ❑X Final
Contractor: Testing Service Carp
Address: 360 S. Main Place
Carol Stream, IL 60188
2'1i- 64
Request for Approval
of Change in Plans
County: McHenry
Road District or Municipality: McHenry
I recommend that this addition be made to the above contract.
(eddldm, wtenslon, ded=iw) (to, frm)
Section No. 05-00000-01-GM
The estimated quantities are shown below and the contractor agrees to furnish the materials and do the work at the unit prices.
Maintenance Engineering
----��
2005 Streetrr0�
BLR 13210 (Rev. 02/03110)
Printed 8/23/2011 1 of 4
BLR 13210 (Rev. 02/03110)
Pdnted 8/23/2011 2 of 4
BLR 13210 (Rev. 02103/10)
Pnnled 8/23/2011 3 of 4
Total Net Change:
Amount of Original Contract:
Amount of Previous Change Orders:
Amount of adjusted/final contract:
$ 1,847.80
$ 13,500.00
$ 15,347.80
Total net addition to date $ 1,847.80 which is 0.1368741 % of the contract price.
(addition, deduction)
State fully the nature and reason for the change: Additional engineering was needed to test the road project.
When the net increase or decrease in the cost of the contract is $10,000.00 or more, or the time of completion is increased or
decreased by 30 days or more, one of the following statements must be checked:
The undersigned has determined that the circumstances which necessitate this change were not reasonably foreseeable
at the time the contract was signed.
The undersigned has determined that the change is germane to the original contract as signed.
11 The undersigned has determined that this change is in the best interest of the Local Agency and is authorized by law.
For County and Road District Projects
Highway Commissioner
Date
Submitted/Approved
County Engineer/Superintendent of Highways
Date
Note: Make out separate form for change in length quantities.
Give net quantities
Submit 6 Originals
If plans are required attached 3 sets.
Prepared by: ���
Finan 8 Accoun g Manager
This of Preparer
Approved
For Municipal Projects
l C
Mu 'c at er
ale o Mun al Office
vkg
)II
Date
Regional Engineer
Date
BLR 13210 (Rev. 02/03/10)
Printed 8/23/2011 4 of 4
(t Illinois Department
of Transportation
Route
County McHenry
Local Agency McHenry
Section 05 - 00000 - 01 - GM
Engineer's Payment Estimate
Estimate No. From 1/1/2005 To 12/31/2006
Payable To: Name Smith Engineering Consultant Testing Service Corp
Address PO Box 8213 Des Moines, IA 360 S. Main Place Carol Stream, IL 60188
Items Awarded' Added Deducted Completed
Quanti Values Quantity Quantity Quantity Unit Price Values
Totals carded forward from previous a e<_ '
Maintenance Engineering 1.00 13,500.00 1.00 15,347.60 15,347.80
IF59 Is Not In
15,347.80 Table
Total Awarded Values $13,500.00 Total Com leted Values $15,347.80
FOR DAY LABOR SECTIONS SHOW ESTIMATED QUANTITIES AND VALUES
Page 1 of 2 BLR 13230 (Rev. 7/05)
Printed on 8/23/2011 8:19:05 AM
05 - 00000 - 01 -
Section Number: GM Total Brought Forward
$15,347.80
Miscellaneous Extras and Credits
Values
Total Miscellaneous Extras and Credits
Total Value of Completed Work
15,347.80
Deduct Retains e
BalanceDue on Com
feted Work
15,347.80
' Miscellaneous Debits
Values
Total Miscellaneous Debits
Net Amount Due
$15,347.80
Signed:
Resident Engineer/Consultant Date
Local Agency
Approved:
I A ncy Date
TlW
Page 2 of 2 BLR 13230 (Rev. 7/05)