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CITY OF SEBASTIAN CHANGE ORDER FORM
CHANGE ORDER #: 11 PROJECT NAME: SEBASTIAN AH2PORT HANGAR C
PURCHASE ORDER #: PROJECT #: 16-04
CONTRACTOR: AHRENS COMPANIES CONTACT NAME: MIKE FISHKIND
ADDRESS: 1461 KINETIC ROAD CONTRACT DATE: AUGUST 10, 2016
LAKE PARK, FL 33403
By the signature affixed below, both the City and the Contractor agree to the changes as stipulated herein. Upon
proper execution of this document, the Contractor is hereby notified to commence work. All changes stated below
are hereby incorporated and made a part of the Contract identified above, and all the terms and conditions of said
Contract are enjoined and in full force while executing the change(s) stipulated as follows:
DESCRIPTION: Provide material and labor to install the electrical devices shown on the plan as "Future".
-Install (1) EWH-I power and (1) circ. pump power complete with disconnect and terminations.
-Install (1) Refrigerator power, (1) Microwave power, (1) dishwasher power, and (1) GFI above counter top.
A) CONTRACT PRICE PRIOR TO THIS CHANGE
NET INCREASE (DECREASE) RESULTING FROM THIS CHANGE
NEW CONTRACT PRICE INCLUDING THIS CHANGE ORDER
B) CONTRACT TIME PRIOR TO THIS CHANGE (NUMBER OF DAYS)
NET INCREASE (DECREASE) RESULTING FROM THIS CHANGE (NUMBER OF DAYS)
NEW COMPLETION DATE INCLUDING THIS CHANGE
AGREED:
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Authorized Signature
Approvals By City of Sebastian Staff.
S 1,185.921.56
S 1,877.39
S 1.187.798.95
305
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June 30, 2017
CITY OF SE ASTIAN-
Date•��
Autho d Ci Manager
City Manager Authorization - cumulative amount less than 15% of contract price or $15,000 single change order.
_ City Council Authorization -cumulative amount exceeds 15% of the contract price or $15,000 single change order.
(Meetingg Date )
CITY OF S BA,STIAN --- - - -
City Manager ® D
Project Manager as to engineering"'�' ✓ VEL
Administrative Services as to budget -
City Attorney %, ,_ , as to legal vette Williams_ ity Clerk
Procurement Manager -y' I as to purchasing .� . — -