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ST0402-CS150609City of Coppell Engineering Department Routing Sheet for Approval of Contracts and Agreements Vendor Name:,aDate: Contracted Work/Project: Explanation: LkAIW.L9ePZL 1 �" Council Approved:No If yes, Date: ,Sr Budget Approved: es No 5> s / O New Vendor'Existing Vendor 0 Renewing Contract Routing Sequence: Initials Date 1. Employee initiating contract/agreement: (Vitt m'r-t C-AQA— z� (Include W-9 & Clgform if vendor is not in system.) 2. Supervisor Authorization: 3. Purchasing Manager/Technician: (Signature needed only if vendor is new to system or contract has been changed since last time used) 4. Director of Engineering Authorization: Ken Griffin 6.30 IS' 5. Deputy City Manager Authorization: Mike Land Comments: 6. City Manager: Comments: 7. Originals back to Administrative Manager: Clay Phillips_ V -L/// Kyra Cody 8. Copy of contract/agreement to Jennifer Miller: YES / NO ,Texas Department of Transportation DALLAS COUNTY OFFICE * 4777 E. HWY 80 * MESQUITE, TX 75243 * (214)319-6502 Michael Garza, P.E. Assistant Director of Engineering Engineering Department 255 Parkway Boulevard Post Office Box 9478 Coppell, Texas 75019-9478 Control: Project: Highway: County: Dear Mr. Garza, 2374-07-058 CC 2374-7-58 IH 635 Dallas April 2, 2015 Please find enclosed the third party funding notification sheet for Change order 7 on the above referenced project. Please return a signed copy via email to Nohemi.Parra@txdot.gov. If you have any questions, please contact me at 214-320-6241 or Elliott Stovall at 214-319-6515. Sin ely, Noel Paramanantham, P.E. Dallas Area Engineer CC: Job Files THE TEXAS PLAN REDUCE CONGESTION - ENHANCE SAFETY - EXPAND ECONOMIC OPPORTUNITY - IMPROVE AIR QUALITY INCREASE THE VALUE OF OUR TRANSPORTATION ASSETS An Equal Opportunity Employer TEXAS DEPARTMENT OF TRANSPORTATION CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 7 Third Party Funding Notification Sheet This form Is used when the subject change order Involves funding by a source other than TXDOTAI.S. DOT, and Involves third parties who are providing funding under an Advance Funding Agreement or Donation Agreement. 1. Outside funding provided by: CITY OF COPPELL (Outside Enlilys Legal Name) 2. Type of outside funding agreement for this change: r Existing F Amended r New ( Check one j 3. Indicate the type and amount of funding: Fixed Price (Lump Sum) (Estimated Amount ) Actual Cost 562,825.99 (b) E&C': (a) x 17.000% = $10,680.42 enter % (c) Indirect Cost": (a+ b) x = S0.00 enter % TOTAL $73,506.41 CCSJ. 2374.07-058 Project: CC 2374-7-58 Idighway. IH 635 County: Dallas District: Dallas Contract Number: 06143210 Use as needed. I hereby acknowledge noti "lion of the modifications covered by this Change Order. Date D -7,02, �5 By Typed/Printed Name ehlttflfs Typed/Printed Title rAz:N (1 AY►AC—IIS_ The percentage (%) for E&C (Engineering and CoMingondes) charges varies from project to project dePmidlnp on the contract amount of the pm*t Prciocts with a higher contrast amount will have a lower rate of 5&C charge. For a speclffc pn4ad. FAG rate (%) can be darted from the cost of'Ernpinewft and Contingencies' In the *Estimated Cost' of the project. Use ft statll"district rate as established by Finance Divhkm each year. This line 3(c) Is for Service Project only, --- -- unless oth spedled In ft /0vence Fuftdfny Agaernent. see Stand Alone Manual Notice .98 2 for inatnx,tlape_ Funding for this Change Order has been arranged: TxDOT Representative Dale Typed/Printed Name: TxDOT Farm 2146•AFA - Dallas District Spacllic (Rev. 06!2007) m IL § Q � � Q S � / � 0 § � ■ z w w 0 � 0 w (D z « _ U 42 E a 2//G f:3 a 2 kJ&\ § > S \ o = e L 0 e /ƒ § - m = m \ / 2 w - ® / \ / \ / 0 §), o z E a = m E 2 C 6 e < * = 2 < LL e z _ o e e&°« > f # m = a/ 2 m k _� u N o Q m z z §§ E f ��❑�❑ //_ §Cko I 2 k� w_&± a 2 §/ / L) 0) w < i /\ e �tff c & p < w w L4 0 4 k E/ z T\ 2 § ? j ( CO / ( \ m i / / \ ° \0. LO \ ® \ m oCL o + o © \ / 0 \ < § § § > k * t00 L) q / a) o= a) 0 </U / m m = a E CL \ § � § of 2 0 ( Z m o & z c%/ § § - ._ c § w § Lu0 » z w w w U)< 0 I » # _ ) 2 2 S a$ § LU ¥ B CL/\ g 2'q I §° / 0 % a m §=a 2 o z m § z ¥ \ L z (L \ \ L \ 0 Z 2 a f \ \ W w ry _ � �f�7 _ n \ % \ , k 2 % $ § % a = % / m o I 2 o Q» 0 m w m §_ q i/� $ % p/%/ 7 g N E\ w* o q= T 0 a g g g/ 2 m © e= I % » R z \ 0 k%\] k\ k 0 t 2/ t §@ � \\§f E %\\ z e e 7§ @ 2= 2 °/SR @ �a- - RE 0 § § /±2 E /z kk� 0• § kw k\\/ \q/ w ®kw k > w §/Eb 0\ °®©« ° w ERG 0 0 $ \ $ k § § \ § 2 B E § § £ D f m @ > ®__ o$IL kkk// 0 /�\SaSaSSS \ < C E N O O C w N N L 4) = C 7 a7 O L L U N f6 N C C d •D m 'O U W N O U N N C � O C axi U L w - co o 'a _ c d' � E m � c O U o c o � o � U CU O (Q C: ccL N E E o .N GN O N 'O c N aS N Oco L E ro U p c C a7 a3 R � C U N N Co v- 3 0 o 5 co a) � a) a3 N N O 0 U M (6 N CC ON U C- a) OE rL U O 'aw O O O)O a7 -6U O` > N O_ O c a7 0 o• ca V) O C y L N m > a 0 aa)i W W Z (D Z LU H U F- N ❑ m H F F- -1 O 13 J W Q Z a W Z F F- 13 W Z LU W Z W N LLI W Z_ w 0 LU a. w 0 }w IL 0 W Q LLI 0 W Q LU F Q Q 1--o § ° ) / @ 0 0w a § Cl) 2 ¥ 6s LO / a CD ELr) oCD z ~ S 0 � 2 m K \ LU 2 0 ) « > a + § � 0 m z LLI w 0 0 k § \ \ § § 00 } E ° \ § 0 \ I k E LU _ ƒ E 0 LL \ _ \ § q m E \ w \] w 00 L? z CES /)Sc § & g F- P: 7 = w k m &2 / E § e ) ± ) y §\ § C) k\k) IL co Lo k z \ / �§\�§ §§ cm N G = Rc /S @�§ )S@ L \ / u LU§ § k § 04 CD CD LY U � a. L) z § Cl rn rn L6 N N 69 Q C' N W R) � OI N 0 a z 0 z U- ,Texas Department of Transportation DALLAS COUNTY OFFICE * 4777 E. KWY 80 * MESQUITE, TX 75243 * (214)319-6502 April 6, 2015 Michael Garza, P.E. Assistant Director of Engineering Engineering Department 255 Parkway Boulevard Post Office Box 9478 Coppell, Texas 75019-9478 Control: 2374-07-058 Project: CC 2374-7-58 Highway: IH 635 County: Dallas Dear Mr. Garza, Please find enclosed the third party funding notification sheet for Change order 8 on the above referenced project. Please return a signed copy via email to Nohemi.Parra@txdot.gov. If you have any questions, please contact me at 214-320-6241 or Elliott Stovall at 214-319-6515. Sincerely, Noel Paramanantham, P.E. Dallas Area Engineer CC: Job Files THE TEXAS PLAN REDUCE CONGESTION • ENHANCE SAFETY • EXPAND ECONOMIC OPPORTUNITY • IMPROVE AIR QUALITY INCREASE THE VALUE OF OUR TRANSPORTATION ASSETS An Equal Opportunity Employer TEXAS DEPARTMENT OF U ANS o" K O o M CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: a Third Party Funding Notification Sheet This form Is used when the subject change order involves funding by a source other than TxDOTN.S. DOT, and Involves third parties who are providing funding under an Advance Funding Agreement or Donation Agreement. 1. Outside funding provided by: CITY OF COPPELL (Outside Entltys Legal Name) 2. Type of outside funding agreement for this change: F/ Existing F Amended New [ Check one 1 3. Indicate the type and amount of funding: Fixed Price (Lump Sum) (Estimated Amount ) Actual Cost -$182.00 (b) EW: (a) x 17.000% _ -$30.94 enter % (c) Indirect Cost (a + b) x $0.00 enter % TOTAL -$212.94 CCSJ. 2374.07-058 Project: CC 2374-7-58 Highway: IH 635 County: Dallas District: Dallas Contract Number: 06143210 Use as needed: I hereby acknowledge notification of the moddicallons covered by this Change Order. Date 7, 02 .15 By Typed/Printe Name (1qM ab jt� -j Typed/Printed Title Cl11�11}�1r'E2 ' The'percentage (tS) for E&C (Engineering and Contingencies) charges varles from project to project depending on the contract amount of the project. Projects wflh a higher ootlract amount will have a tower rate of E&C charge. For a speolfic prnjed, E&C rate (%) can be derived from the cost of 'Erdneering and Ccntingencles' m the.'Estimated Cost* of ft project. Use the statewkle district rate as established by Finance Division each year. 7N Ilse 3(c) is for Service PMOW only, unless otttenvtsa ap"fled in the AdvM"' Ftktil N Agreement, See Stand Note Manual Notice 98.2 for instructions. Funding for this Change Order has been arranged: TxDOT Representative Da1e Typed/Printed Name: TuDOT Form 2146-AFA- Dallas Diatrict Specific (Rev. 08/2007) n 2 D z O m O v m z W 00 .P. N 0 N Gf K ;u= -X m o x<<d o� o -I n p v D w n n n D n -v n m m v CD m ® O D z O n z O z D D m v O n �' T. m co v -4 F - -4 F n < 3 -4 m X -A m -4 ? Ct CD m W m e o� Y o czi X � m co p o 3 0 3 m o� z Z o_ z N= � _ a -q m D O 0 O m m --1 m -4 m n o a N D m= . m= n v o = r D c v v m o? r r(D r -m -0 ani m p 3 z In z 0 O = -�'� sv 'i a C O m r o a m m a m a U) D z D m m o o z -xl CD -x1 o v CO r N a O -u m co = z o� y ya c � „ o N m CD Ou,� oNN��w 3 •p p m v '� n - X N -1 = m co D co A N '-I N o W N Cl) W w 0 vCD ,�-� m m w r- '• 90 Ro o co n p o r o oo'o oJo o coil S o -o 0 y m 0 Do � X X o \ <° z m z 00 U)(a to co Uri 3 m m X v (D rn A g a OT c o Z Z n m vc D n oM. m m E D = z v v3, m w (D c° m D O :Ta a _ (o (D 3 v C7 z (D CL o v d D -< m c 77 � (D�' W CL n �T. y a m G) Z G) m 0) 3o m m m m v co a n A Z (D a � a m=r v= m m m m O CD CD (Dv �o o s cn = O ccnn n z 0 X D D z _ z n� _iv v o { Q m 3 5' m z m z `� fl m 1 (D w d A m m tn� x 0 m 0 c N X. z n 0 z v o Ci N z zEr �' < -Ni m co '< o 70 r 3 n 0 < c CD _ _ m n a m oo n O D w m i o a — r. x n �D O z v o �, 3 m m v cn (D _ -i 00 3 0 CD E O Z D O z : 0 co CO) p m CO Q :3x O x z (D - CL m x v w _ -Oi co D CL � D v (D O Cl) Sp < T 0w co m m� m 0 'c❑❑�❑� cID 0 Z 3 Z O Sp zg cn-1O m cn cV) o m a v a (D co CD y �_ n o 3 0 o � z Z ;;! 0 0 c w X 3 u O 5 3 m Q. 73* m cn CD c N .� N U1 z � v ❑ ❑ ❑ ❑ o o -n -n (D (D p D D D D D fD 0 m m m m a o m(D .C�« C- 3 3 a n 2 D z O m O v m z W 00 .P. N 0 N Gf K ;aj 0 z z \ 0 CD m k z § § CY) en m m � � 0 o n =i \ \§Gm ;= q= \ C) t % \ j z CD Clco W co co ;u g m g m a 6 9 § 9 § i o a§ »§ § \ 2 / z / ) ) _ 90 90§ \ \ m w w p % Q o a s 5 m 0 2 e m 0 m § � � c n -n z § 0 o § j m 5 2 0 Cl m \ m X 3 � o � 00 com f \ \ j < / C) 2 M \ \ 2 § \ \ j 0 z o m \ Cl Cl \ CD � \ z 2 m ° �\ \ ko\ m c z 0 0 z 0 0 cc c 0 n 3 m N wt 00 N O O 00