CONTRACT CHANGE ORDER FORM
CONTRACT INFORMATION
CHANGE INFORMATION
Prior Contract Price
Change Order Amount
New Contract Price
Prior Time of Completion Working Days
Adjusted/Extension Time in Working Days
New Completion Time in Working Days
Estimate of Cost
Contract Unit Prices
Extra Work
Agreed Prices
Eliminated Items
Total
% Change
Original Time Completion in Working Days: N/A
N/A
$ 299,284.35
N/A
N/A
This Change Order Totals To Date
$ -
$ 40,812.35
$ -
$ -
Date: 4/15/26
Change Order Number: 1Bid/Contract Number: N/A-Emergency Work Project Description: Emergency Storm Drain Repair Work on Valley Boulevard at Elm and Hemlock
Contractor: Gentry General Engineering, Inc. PO/Contract Number:
Original Contract Price: $258,472.00
$ 258,472.00
$ 40,812.35
$ 40,812.35
15.79%
$ -
$ 40,812.35
$ -
$ -
$ 40,812.35
15.79%
Contract Change Order No. 001 Page 1 of 3
CONTRACT CHANGE ORDER FORM
INITIATING PARTY (Party responsible for initiating the change order request) Change Initiated By Agency Change Requested By Contractor
REASON(S) FOR THE CHANGE ORDER
Detailed Justification (Required): As part of the repair work for the collapsed storm drain boxes/culverts at the two locations, addiitonal length of repair was required and authorized in the field to ensure there was no delay in the progress of the work.
Execution of this change order by the Contractor constitutes a binding accord and satisfaction that fully satisfies, waives, and releases the Owner from all claims, demands, costs, and liabilities, in Contract, law or equity, arising out of or related to the subject of the change order, whether known or unknown, including but not limited to direct and indirect cost and/or damages for delay, disruption, acceleration, loss of productivity, and stacking of trades, as well as any consequential damages.
Contract Change Order No. 001 Page 2 of 3
A.
1. 2.
Cost (Article A)---
B
1. 2.
Cost (Article B)---
C.
1. 2.
Cost (Article C)---
D.
1. 2.
Cost (Article D)---
TOTAL COST --- (CCO #001) ---
Actual quanities performed have been adjusted based on field conditions. Original contract work was authorized in the amount of $258,472 including headwall reconstruction and paving. Final contract quanitites amounted in a total cost of $199,421.25 resulting in a reduction of cost of Article D, shown below.
The Contract time shall be extended by zero (0) additional Working Days by way of this change order item (Article D.1). ($59,050.75)
$40,812.35
Reference is made to Gentry General Engineer, Inc.'s Invoice V&E WEST dated 3/24/26:
While working in the field on the repair, it was determined that an additional 7' of repair was needed to ensure sufficient structural integrity of the drainage system.
The City directed the Contractor to proceed with the repairs on a verbal agreement to proceed at a cost of $1,958.10/LF. The extra work resulted on the cost of Article C, shown below.
The Contract time shall be extended by zero (0) additional Working Days by way of this change order item (Article C.1). $13,706.70
Quanitity Balancing. Reference is made to Gentry General Engineer, Inc.'s Invoices dated 3/24/26 & 3/31/26:
Reference is made to Gentry General Engineer, Inc.'s Invoice V&H EAST dated 3/24/26:
While working in the field on the repair, it was determined that an additional 30' of repair was needed to ensure sufficient structural integrity of the drainage system.
The City directed the Contractor to proceed with the repairs on a verbal agreement to proceed at a cost of $1,958.10/LF. The extra work resulted on the cost of Article B, shown below.
The Contract time shall be extended by zero (0) additional Working Days by way of this change order item (Article B.1). $58,743.00
Reference is made to Gentry General Engineer, Inc.'s Invoice V&H SE COR dated 3/31/26:
The Contract time shall be extended by zero (0) additional Working Days by way of this change order item (Article A.1).
CONTRACT CHANGE ORDER NO. 001
$27,413.40
While working in the field on the repair, it was determined that an additional 14' of repair was needed to ensure sufficient structural integrity of the drainage system.
The City directed the Contractor to proceed with the repairs on a verbal agreement to proceed at a cost of $1,958.10/LF. The extra work resulted on the cost of Article A, shown below.
(Continuation of CCO No. 001)
The contract is changed in accordance with the following work scopes. The equitable adjustments of both, cost and time are delineated for the article listed.
Contract Change Order No. 001 Page 3 of 3