DATE: 9/19/2023
PROJECT DESCRIPTION:
PROJECT NO: CIP 13-03 PURCHASE ORDER NO: 04396
CONTRACTOR:
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
DESCRIPT
ION U/M QUANTITY UNIT PRICE TOTAL
1 FA 1 $3,412.35 $3,412.35
TOTAL ESTIMATED PRICE FOR THIS CHANGE ORDER: $3,412.35
JUSTIFICATION: (Be specific on each item. Attach supporting documents as necessary)
1. A
n existing Southern California Edison (SCE) concrete encased duct bank was in conflict with the CIDH piles and footing for bridge abutment #4.
T
he existing duct bank is shown in a different location on the plans. SCE relocated the duct bank to avoid the conflict. However, the Contractor had to remove existing concrete duct bank.
CONTRACT CHANGE ORDER NO. 06
CITY OF MENIFEE
DEPARTMENT OF PUBLIC WORKS
Holland Road Overcrossing at Interstate 215
The additional work will be compensated at force account Riverside Construction Company
Remove Southern California Edison's (SCE) concrete encasement at Antelope Road/Holland Road (Abutment #4)
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.
C:\Users\phann\Downloads\CCO 06
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 CONTRACT CHANGE ORDER NO. 06
CITY OF MENIFEE
DEPARTMENT OF PUBLIC WORKS
CONT
RACT VARIANCE SUMMARY
CCO # Amount %
01 $20,537.39 0.08%
02 $49,000.00 0.19%
03 ($9,000.00) -0.03%
04 $0.00 0.00%
05 $16,824.94 0.07%
06 $3,412.35 0.01%
Totals $80,774.68 0.31%
$25,848,403.85 January 10, 2023
$77,362.33 March 28, 2024
$3,412.35 0
$25,929,178.53 March 28, 2024
AUTHORIZATION BY CITY:
Recommended for approval by:
Date: __________ Date: __________
Approved by:
Date: __________ Date: ___________
ACCEPTANCE BY CONTRACTOR:
We, the undersigned Contractor, have given careful consideration to the above described changes and/or extra work and hereby agree that said work is a supplement to the contract and all provisions will apply hereto.
Accepted by: _____________________________________________________ Date: ____________________________ Signature
_____________________________________________________
Please print name and title
Previous Change Order Amounts:
Current Change Order Amount:
Revised Contract Amount:
City Manager
Nicolas Fidler
Amr Abuelhassan, Southstar Construction Manager Carlos E. Geronimo, City Project Manager Armando G. Villa
0 0
7/27/2023 Increased Girder Flare Thickness
Exc. Abut. #4/Fire Hydrant extra work
Remove SCE's concrete encasement
0 0
12" C900 DR 14 Fusible Pipe
Director of Public Works/Engineering
________________________________________________________________________________ __________________________________________________________________________ Original Contract Amount:
0 0
Additional Time
5/15/2023
5/31/2023Irrigation Modifications Plan IP-5
9/5/2023
Extra Work for miscellaneous items
Revised Completion Date:
0 Date Started:
Original Completion Date:
Additional Time (Working Days)
Description Date Approved
4/17/2023
C:\Users\phann\Downloads\CCO 06
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 Ryan Camp
9/19/2023
Projects Manager
DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 9/19/2023
9/19/2023
9/20/2023
9/21/2023
Holland Rd Overcrossing at I-215 Project
CCO #06
Report #41 2,271.69$
Report #42 1,140.66$
Total 3,412.35$
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48
STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT# 7541-3496-7
Date Performed Date of Report Con. Job No. Cont. Apt. No. 7/24/23 8/22/23 22014 41.0
Work Performed By
Riverside Construction Company, Inc.
Description of Work
REMOVE SCE ENCASEMENT AT ANTELOPE/HOLLAND
For Resident Engineer's Use Only
Date Received
□ NewBlll 0 Approved for Payment
0 Resubmittal 0 Returned for Correction
Date of Action
Contract No.
CASEWB
CCONo. Page
22014 915
Report No.
E.W. A.C.
+ • FA LS UP FA LS UP BR
+ X
Attached to This Bill Are:
[8J Labor Charges CEM-49028
0 Equipment Charges CEM-4902C
0 Material Charges CEM-4902D
41.0 Partnering
Switch
N
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up otal Equipment (A)
otai Materials (8)
Subtotal Equipment & Materials (A) + (8)
� % Standard Mark-up
Total Equipment & Materials (Al + (8) + Standard Mark-up otal Regular Labor (C)
otal Premium Labor (D)
□ % Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (C) + (D) + Regular Surcharge+ Premium Surcharge otal Subsistence (E)
gnature (Resident Engineer)
Signature (Prime Contractor's Representative)
933.021
0.001
933.021
93.301
1,026.321
878.881
79.101
0.001
878.881
957.981
0.001
FM 941992M White - Data Entry Canary - Resident Engineer Pink - Contractor (Aller Approval) Total Other Expenses (F)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge + (E) + (Fl � % Standard Markup
Total Labor (Cl + (D) + Surcharge+ (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials+ Labor
� % of Mark-up on Subcontracted Work (Only)
GrandTotat
In Case of Question:
0.001
957.981
287.391
1,245.371
1,026.321
2,271.691
0.001
2,271.691
CCO 06
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION CASEWB 41.0
EXTRA WORK BILL - LABOR CHARGES
CEM-4902B (NEW 7/94) CT# 7541-3497-9 I Contract No.
I
CCO No.
l
Report No.
I
Labor su
9 harge I WCI Class I WCI Rate
I Pag
2 22014 915 OF 3
Name Regular Hours Premium Hours Subsistence
Craft ID Int Last Hrs Rate Total Hrs Rate Total Units Rate Total 34 OE M STEPHENSON 8.0 91.600 732.80 120.995
35 LBR DG GUTIERREZ 2.0 73.040 146.08 96.055
36 37
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
Total(C) 878.88 Total(D) Total (E)
OTHER EXPENSES SUBJECT TO LABOR MARKUP
Description Amount
54 Travel Expense Extended Total (F)
Units Rate
Signature /Resident Engineer} In Case of Question:
(Resident Engineer's Use Only)
Signature /Prime Contractor's Representative)
n.,� 8/2-'i/?"?
Name
I
Business Phone
FM 941991 M White • Data Entry Canary - Resident Engineer Pink -Contractor(AtterApproval) Goldenrod - Contractor EWBfffs.com DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
DC-CEM-4902C (NEW 7/94) CT# 7541-3498·1
Equip ID Number Class Make
04 1167 LDRRT CAT
05 4179 TRUCK T&TT
06 07
08 09
10 11
12 13
14 15
16 17
18 19
20 21
22 23
Signature of Resident Engineer
Contract No.
22014
Equipment Desc_rlptlon Regular Overtime
Code Attach Hours Hours
1869E 8.00
12-20 2.00
In Case ol Question Contact:
(Resldant Engineer's Use Only)
Signature of Prime Contractor's Representative
{!�.-1-- 8/7-41-z,-:;
Name
FM 941987 M ,-White - Data Entry Ca'lfary - Reslaent EngTn�er Pink - Contractor (Atter Approval) Goldenrod - Contractor CASEWB 41.0
CCO No. Report No. I Pag
3915 OF 3
Reg OT Extended
Rate Rate Amount
102.95 823.60
54.71 109.42
Total(A) 933.02
Business Phone
EWB/1/s.com
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48
IVERSIDE
CONSTRUCTION
COMPANY, INC. DAILY EXTRA WORK DIARY
AGENCY: _,._c_\ -'--11L....>...;1 ,L___.!.1\-'-':C,__________._----'--'---'-"'"--'-':...:.....:.-=---- PROJEC��l-�f�A�l�l �r-�--���--
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DATE WORK PERFORMED: ___ l_z_v_/_7_3 ______ _
JOB NO.: 22 0\\(
SUBCONTRACTOR: ______________ _ ,
(IF NOT PRIME)
Description of work performed and location: �����-��---''-'-'_G_/\_�_1 �'�"-"'-'�"N __ T __ tl_T ________ _ J\�Tu Ge� l /1 Lu.,>,.,•�-
LABOR:
EMPLOYEE CLASSIFICATION HOURS
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CONTRACTOR'S REPRESENTATIVE
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DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT# 7541-3496•7
01 Date Performed
8/07/23
Date of Report
8/22/23
Con. Job No.
22014
02 Work Performed By
Riverside
Construction Company, Inc.
Contract No.
Cont. Rpt. No.
42.0 CCO No.
22014 915
Report No.
E.W. A.C.
+ • FA LS UP FA LS UP BR
+ X
CASEWB
Page
42.0 Partnering
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N
03 Description of Work
HAUL OFF SCE ENCASEMENT CONCRETE FROM AREA AT ANTELOPE/HOLLAND □ NewBIII
D Resubmlnal
otal Equipment (A)
otal Materials (B)
For Resident Engineer's Use Only
D Approved for Payment
D Returned for Correction
Subtotal Equipment & Materials (A) + (B)
� % Standard Mark-up
Total Equipment & Materials (A) + (B) + Standard Mark-up otal Regular Labor (CJ
otal Premium Labor (D)
□ % Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (C) + (D) + Regular Surcharge+ Premium Surcharge otal Subsistence (E)
Signature /Resident Engineer)
Signature (Prime Contractor's Representative)
FM 94
1992 M White - Data Entry
Date Received
Date of Action
Attached to This Bill Are:
0 Labor Charges CEM-4902B
0 Equipment Charges CEM-4902C
D Material Charges CEM-4902D
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up 517.271
0.001
517.271
51.731
569.001
403.431
36.311
0.001
0.001
403.431
439.741
0.001
Pink - Contractor /Alter Approvslj
Total Other Expenses (F)
Subtotal (C) + (DJ + Regular Surcharge + Premium Surcharge + (E) + (F) � % Standard Markup
Total Labor (C) + (D) +Surcharge+ (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials+ Labor
� % of Mark-up on Subcontracted Work (Only)
Grand Total
In Case of Question:
(Resident Engineer's Use Only)
0.001
439.741
131.921
571.661
569.001
1,140.661
0.001
1,140.661
CCO 06
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL • LABOR CHARGES
CEM-49028 (NEW 7/94) CT# 7541-3497-9 I Contract No.
22014 I CCO No. I Report No.
915 I
Name Regular Hours Premium Hours
Craft ID Int Last Hrs Rate Total Hrs Rate
34 OE A ·PERCIVAL 2.0 91.600 183.20 120.995
35 TMS B HERNANDEZ 3.0 73.410 220.23 93.270
36 37
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
Total(C) 403.43 Total (D)
OTHER EXPENSES SUBJECT TO LABOR MARKUP
Description
54 Signature (Resident Engineer)
-
Signature (Prime Contractor's Representative)
n,,<;;;, 8�lf /z3
Name
FM 941991 M While - Data Entry Canary - Resident Engineer Pink - Contractor (Aller Approval) Goldenrod - Contractor CASEWB 42.0
Labor Su
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WCI Class
I
WCI Rate
1P
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2 OF 3
Subsistence
Total Unlls Raia Total
Total(E)
Amount
Travel Expense Extended Total (F)
Unlls Rate
In Case of Question:
(Resident Engineer's Use Only)
I
Business Phone
EWB/1/s.com
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
DC-CEM•4902C (NEW 7/94) CT#7541-3498-1
Equip ID Number Class Make
04 1167 LDRRT CAT
OS 2041 TRUON TRUN
06 07
08 09
10 11
12 13
14 15
16 17
18 19
20 21
22 23
Signature of Resident Engineer
Contract No. CCO No.
22014 915
Equipment Description Regular overtime Reg
Code Attach Hours Hours Rate
1869E 2.00 102.95
4AXL 3.00 103.79
In Case of Question Contact:
(Resident £nglneer·s Use Only)
Signature of Prime Contractor's Representative
� S/-z.'f h.. 3
Name
FM 941987 M White - Data Entry Can1!ry - Resident Engineer Pink - Contractor (ANer Approval) Goldenrod - Contractor CASEWB 42.0
Report No. I Pag
3 OF 3
OT Ex1ended
Rate Amount
205.90
311.37
Total(A) 517.27
Business Phone
EWBi/1s.com
DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48
IVERSIDE
CONSTRUCTION
COMPANY, INC.
AGENCY: C , n/ ,.... r k. I k ,._ > , r l 7--
PROJECT: kl ( \ \ \ /,.. () � l \ a\. oc.
JOB N0.:_�2�7�c�\�\_t _________ _
COST CODE: �_l_-_9_o_o _______ _
DAILY EXT RA WORK DIARY
DATE WORK PERFORMED: __ o-'-/�1�/�z�3-----==-----
SUBCONTRACTOR:______,=------=-------------
(IF NOT PRIME)
Description of work performed and location: -�' �/1�1�t �' '=��n�r_-r-����c.�t-�&=-��.,__,,-1-'---=s;--'-(-_1_1_1-'-t _?\.._l_1 __ l<_o=-.c._10_c-'-rz_---=-l'_,_,,"--- i7 rry,\ /\ ,- AW 1"'r(CWF I/ h)t k A 10-0 �"::> ,
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DocuSign Envelope ID: 52507910-A5E6-43EA-91D8-F82660C34C45 DocuSign Envelope ID: 05E7861C-A2D8-48AC-8F9B-F73C91979F48