190015-CHANGE ORDER #4.PDF

Maricopa County — Formal (2021-11-17)

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12-31-23
sb

Procurement Type: 
  Article 3  
  Article 5  
  Article 5 Term 
 Other (please specify) 
    New Delivery Order 
Project Manager: 
     TM or Change Order #: 
Phone #: 
Date:  
Project #: 
Vendor Name: 
Project Name: 
Contract #: 
Location Name: 
Delivery Order #:   
Amount:  
Funding Source: 
 MM  
 CIP 
 Annual Funds 
 User Funds 
FUND 
DEPT 
UNIT 
ACTIVITY APPR UNIT 
OBJ/SUB 
LOCATION 
(Bldg #) 
PROGRAM 
PHASE 
AMOUNT 
APPROVAL OR REVIEW REQUIRED 
DATE 
INITIAL 
1.
All information has been reviewed by Project Manager
2.
Additional Special or Requested Review (Specify) ____________________
3.
FMD Procurement Review
4.
Budget Analyst Review
5.
FMD Design and Construction Division Manager Approval
6.
FMD Director Approval
7.
OPS Article 5 Change Order Processing (if Applicable)
8.
Delivery Order Processing
*Contract change orders to be reviewed by director first
Delivery Order Total to Date
$ 
DESCRIPTION OF PROJECT SCOPE OR CHANGE ORDER: 
(A total summary of all Task Modifications or Change Orders to date should be provided above, if space is limited insert below) 
Required Attachments: 1. Vendor Proposal with Supporting Documentation & Schedule 2. Task Mod/Change Order Signature Sheet (If Applicable) 
3. Vendor rate sheet from contract (PM to verify and initial rates on vendor proposal) 4. Budget Summary and Estimate Sheets
*For Article 5 Change Orders please provide the signature authority matrix
Delivery Order, Task Modification, & Change Order Routing Form Rev 07/2021 
SB
10/18/21
NA
I
I
4
10/15/2021
Gould Evans INC
MA5190015
DO,190000009331-8
Angel Miranda
602-527-3538
2895-19-0005
SECJC
Mesa Campus
$29,650.00
I
442
D470
4713
FACM
SRJC
9150-11
2895
SRJC
CAPBLD
$29,650.00
N/A
10-15-21
10/18/21
101821
See Below
History:  $248,040.00 + $10,078.00 + $3,138,562.00 + $180,000.00 + $29,650.00 = $3,606,3300.00 
Additional Design Services:  Lobby Revisions, Network Revisions, Additional FTR Support, Elevator Revisions, Circuit Amperage Revisions, Deferred
Submittal Coordination
10/15/21

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10/12/2021
10.13.21
Melissa M. Farling, Principal Gould Evans
N/A
BY __________________________________
     CHAIRMAN, BOARD OF SUPERVISORS
BY __________________________________
     CLERK OF THE BOARD
ATTESTED:
____________________
DATE:
____________________
DATE:
10-18-21
190015

Copy of ASR 04_R1a
10/7/2021
Page 2

Copy of ASR 04_R1a
10/7/2021
Service
category Gould Evans
Arch
Henderson
MEP+FP
MBJ
Structural
Dibble
Civil
GBTwo
Landscape
open
open
Subtotal By Service
Lobby Revisions
fee
 $       4,860.00  $       1,255.00  $                   -    $                   -    $                   -   
$       6,115.00 
Network Revisions
fee
 $           330.00  $       4,540.00  $                   -    $                   -    $                   -   
$       4,870.00 
Additional FTR support
fee
 $       3,625.00  $       3,460.00  $                   -    $                   -    $                   -   
$       7,085.00 
Elevator Revisions
fee
 $       1,332.50  $       1,515.00  $       2,632.50  $                   -    $                   -   
$       5,480.00 
Circuit Amperage Revisions
fee
 $          330.00  $       2,140.00  $                   -    $                   -    $                   -   
$       2,470.00 
Deferred Submittal Permit Coordination
fee
 $       3,630.00 
$       3,630.00 
Subtotal by Staff
 $     14,107.50  $     12,910.00  $       2,632.50  $                   -    $                   -    $                   -    $                   -   $      29,650.00 
Service
category Principal
Sr. Project 
Manager
Sr. Technical 
Architect
Project/Int 
Designer
Project 
Architect
Designer
Admin
Subtotal By Service
rate
 $                220  $                185  $                165  $                155  $                140  $                130  $                  70 
Lobby Revisions
hours
2.0
14.0
4.0
12.0
fee
 $                   -    $                370  $             2,310  $                620  $                   -    $             1,560  $                   -   $        4,860.00 
Network Revisions
hours
2.0
fee
 $                   -    $                   -    $                330  $                   -    $                   -    $                   -    $                   -   $            330.00 
Additional FTR support
hours
15.00
2.00
4.00
fee
 $                   -    $             2,775  $                330  $                   -    $                   -    $                520  $                   -   $        3,625.00 
Elevator Revisions
hours
6.5
2.0
fee
 $                   -    $                   -    $             1,073  $                   -    $                   -    $                260  $                   -   $        1,332.50 
Circuit Amperage Revisions
hours
2.00
fee
 $                   -    $                   -    $                330  $                   -    $                   -    $                   -    $                   -   $            330.00 
Deferred Submittal Permit Coordination
hours
22.00
fee
 $                   -    $                   -    $             3,630  $                   -    $                   -    $                   -    $                   -   $        3,630.00 
Subtotal by Staff
 $                   -    $       3,145.00  $       8,002.50  $           620.00  $                   -    $       2,340.00  $                   -   $      14,107.50 
Service
category Principal
Project 
Manager
Lead Engineer 
(MEP)
Engineer (MEP) Engineer 
(FP, IT, SEC)
BIM/Cad
Admin
Subtotal By Service
rate
 $                190  $                140  $                140  $                130  $                140  $                  85  $                  85 
Lobby Revisions
hours
1.0
1.0
2.0
4.0
1.0
fee
 $                190  $                140  $                280  $                   -    $                560  $                  85  $                   -   $        1,255.00 
Network Revisions
hours
2.0
6.0
12.0
4.0
8.0
fee
 $                380  $                840  $             1,680  $                520  $             1,120  $                   -    $                   -   $        4,540.00 
Additional FTR support
hours
2.00
2.00
12.00
8.00
fee
 $                380  $                280  $             1,680  $                   -    $             1,120  $                   -    $                   -   $        3,460.00 
Elevator Revisions
hours
1.0
1.0
4.0
2.0
2.0
1.0
fee
 $                190  $                140  $                560  $                260  $                280  $                   -    $                  85 $        1,515.00 
Circuit Amperage Revisions
hours
2.00
1.00
6.00
6.00
0.00
fee
 $                380  $                140  $                840  $                780  $                   -    $                   -    $                   -   $        2,140.00 
Subtotal by Staff
 $       1,520.00  $       1,540.00  $       5,040.00  $       1,560.00  $       3,080.00  $             85.00  $             85.00 $      12,910.00 
Service
category Principal
QA/QC
Project 
Manager
Project 
Engineer
Engineer
Designer
Special Struc 
Insp
Open
Subtotal By 
Service
rate
 $                165  $                140  $                125  $                110  $                  95  $                155  $                   -   
Elevator Revisions
hours
2.0
10.5
6.0
4.0
fee
 $                   -    $                280  $             1,313  $                660  $                380  $                   -    $                   -   $        2,632.50 
Subtotal by Staff
 $                   -    $           280.00  $       1,312.50  $           660.00  $           380.00  $                   -    $                   -   $        2,632.50 
A.   ASR 04-R1 SERVICE AND FEE SUMMARY
B.   ASR 04-R1 BREAKDOWN BY DISCIPLINE
STRUCTURAL ENGINEERING SERVICES
ARCHITECTURAL SERVICES
MEP ENGINEERING SERVICES
Page 3