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Home My WebLink AboutECC - CCO 009 - Signed.pdf Co County of Fresno 1 Department of Public Works and Planning 0 18560 Development Services&Capital Projects Division ARE`' Steven E.White,Director PROJECT MANAGEMENT CONSTRUCTION CHANGE ORDER REQUEST This Document is for Fresno County Internal Use Only Project: Environmental Compliance Center Contract No.: 20-S-01 Date: 8/9/2023 Contractor: BMY Construction Group, Inc. Architect: Roger Davidson Change Order No.: CCO#9 Construction Contract Dollar Amount as awarded on 7/13/2021 $2,660,000.00 Director's Change Order Limit: $145,500.00 Contract Time(Calendar Days): 200 Construction Start Date: 09/13/21 Original Construction Completion Date: 3/31/22 Change Order Scope of Work: PCO#29-ADA Concrete Walk PCO#30-Time&Material Tesco Panel Feed Attachment(s): CO Summary,CO Proposal,PCO estimate Net Additive Change Order Dollar Amount: $59,111.39 Net Additive Calendar Days: �0 Net Deductive Change Order Dollar Amount: Net Deductive Calendar Days: 00 Total Change Order Dollar Amount To Date $131,931.14 Adjusted Contract Dollar Amount: $2,791,931.14 Total Adjusted Calendar Days To Date: 139 Director's Change Order Limit Balance: $13,568.86 Adjusted Construction Completion Date: 08/17/22 Reviewed: Royer Davidson ! G�G{VlOG—3 y r davidson(AY¢10,3@3roit 0840 PDT Ayrch�itect Reviewed: Keith Eckert 11 Project Manager Reviewed: Mandeep S. Sekhon r "5' Construction Manager Reviewed: Will M. Kettler � - Division Manager Reviewed: Steven E. White Director Approved: Sal Quintero Not Applicable Board of Supervisors Chairman Director Approval Date: Oct 13,2023 Scan and forward Director Approved Copy to: CAO Paul Nerland Resources Craig Nickel PWP Business Office Jamie Sylvester Staff Analyst Linda Guerra Few COUP County of Fresno 19 Department of Public Works and Planning O� 50 Development Services&Capital Projects Division FRES Steven E.White,Director COUNTY CHANGE ORDER REQUEST Project: Environmental Compliance Center Contract No.: 20-S-01 Date: 8/9/2023 Contractor: BMY Construction Group, Inc. 5485 E.Olive Ave. Fresno,California 93727 (559)243-4200 Change Order No.: CCO#9 Construction Contract Dollar Amount as awarded on 7/13/2021 $2,660,000.00 Original Construction Completion Date: 03/31/22 CCO#9 is hereby approved by the County. Scope of Work: PCO#29-ADA Concrete Walk PCO#30-Time&Material Tesco Panel Feed Attachment: CO Summary,CO Proposal,PCO estimate Net Additive Change Order Dollar Amount: $59,111.39 Net Additive Calendar Days: �0 Net Deductive Change Order Dollar Amount: $0.00 Net Deductive Calendar Days: �0 Total Change Order Dollar Amount To Date: $131,931.14 Adjusted Contract Dollar Amount: $2,791,931.14 Total Adjusted Calendar Days To Date: 139 Adjusted Construction Completion Date: 08/17/22 Keith Eckert Kei h ckert(Aug 9,2023 14:26 PDT) Project Manager Date: Aug 9,2023 By signing acceptance of this Change Order,the Contractor shall agree to the following: 1.Provide all equipment,material,labor and services required to complete the Scope of Work specified in this Change Order. 2.The revised adjusted Contract dollar amount and time extension shown in this Change Order as payment in full. In the event the Contractor does not sign acceptance of this Change Order,Provisions under the Agreement 20-S-01 Article VI shall apply. Accepted By: BMY Construction Group,Inc. ERIC L BOWER(Aug 9,2023 17:47 PDT) Authorized Signature Date: Aug 9,2023 When completed by the Contractor, please scan and return Hard Copies and Color PDF copy to: Linda Guerra,Staff Analyst lindaauerraPfresnocountvca.gov Fresno County Department of Public Works and Planning,Development Services&Capital Projects Division 2220 Tulare Street,Eighth Floor Fresno,CA. 93721 CHANGE ORDER SUMMARY Project: Environmental Compliance Center D. 1VW Days Description Change Orders 1 11/9/2021 $0.00 -$14,820.00 0 Includes PCO#1 2 1/6/2022 $36,635.08 $0.00 0 Includes PCO#3,4.1 3 3/21/2022 $22,784.56 $0.00 4 Includes PCO#2 4 5/2/2022 $2,811.62 -$30,720.00 27 Includes PCO#5.1,6.2,8,and 11 5 6/24/2022 $5,131.09 $0.00 7 Includes PCO#10.1, 13 6 10/6/2022 $32,383.14 $0.00 91 Includes PCO#9, 14.1, 16, 17, 18 7 12/19/2022 $16,740.88 $0.00 10 Includes PCO#12.1,21,22,23,24,26 8 3/28/2023 $1,873.38 $0.00 0 Includes PCO#25 9 8/8/2023 $59,111.39 $0.00 0 Includes PCO#29,30 Totals $177,471.14 -$45,540.00 139 Proposed • • A.. Credit Rejected Pending � . Change Orders 1 1 -$14,820.00 0 Omit 8'sidewalk on the north side of site 2 3 $22,784.56 4 Add fire system at PH1 -Shade Structure 3 2 $830.28 0 Storefront finish alteration 4 $37,711.89 0 Revised Fire Line per C4.0 4.1 2 $35,804.80 0 Revised Fire Line per C4.0-Alterations to site utility plan 5 $0.00 3.5 Rain Delays 5.1 4 $0.00 4 Rain Delays 6 -$28,000.00 0 Tire bark credit 6.1 Not used 6.2 4 -$30,720.00 0 Tire bark and labor credit 7 Not used 8 4 $0.00 23 Time extension for Metal Building Supply issues 9 6 $2,618.36 0 Flooring change PH2-ASI#3 9.1 $2,618.36 0 Flooring change PH2-ASI#3 10 $14,141.00 7 Refabricate Risers at Building 1 &2 10.1 5 $3,596.93 7 Refabricate Risers at Building 1 &2 11 4 $2,811.62 0 Frame Parapet PH2&Pony Walls PH3 12 $13,490.00 10 Time extension for Submittal#34 12.1 7 $0.00 10 Time extensions-Submittal#34-PH1 Shade structure 13 5 $1,534.16 0 Rebar add,credit move strip&PH1 footing sizes 14 $4,819.08 0 Emergency eyewash station cost increase 14.1 6 $2,158.00 0 Emergency eyewash station cost increase 15 Not used 16 6 $0.00 91 Time extension-MSB delays 17 6 $20,645.00 0 T&M for retaining wall at transformer pad 18 6 $6,961.78 0 Tie into existing Fire line 19 $63,029.00 0 HHS&purlin changes at shade structure 20 $51,103.42 0 Street light plan changes from bid to approved set 21 7 $5,478.48 0 Removal of dirt at Transformer Pad 22 7 $3,165.07 0 Electrical for PIV location change 23 7 $1,316.44 0 Lower DI due to drawing conflict 24 7 $2,467.60 0 Relocate 3"drain line due to footing conflict 25 8 $1,873.38 0 Drywall repairs for moving plug in restrooms 26 7 $4,313.29 0 Paint perimeter C-Channel PH1 27 Not used 28 -$750.00 0 Credit for Lift Gates 29 9 $7,348.10 0 ADA Concrete Walks 30 9 $51,763.29 0 IT&M Tesco Panel feed 31 Not used 32 Not used 33 Not used 34 Not used 35 Not used Totals $177,471.14 j -$45,540.00 1 $158,162.75 $0.00 CONSTRUCTION GROUP INCORPORATED July 20, 2023 County of Fresno Construction Division Attn: Keith Eckert 2220 Tulare Street, 7th Floor Fresno, CA 93721 Re: Envirnmental Compliance Center BMY JOB NO.21008 Subject: PCO#29 ADA Concrete Walks Mr. Echert, BMY Construction Group, Inc. (BMY) is providing the following PCO for the costs and time associated for demo existing concrete and installed ADA compliant walks in front. BMY is requesting the County to issue a Change Order adding $7,348.10 to the contract price. In order to perform the work BMY is requiring a time extension of 0 calendar days. This PCO is valid for 30 days. Due to unprecedent times in our industry, with volatile material pricing and delivery, it is of the utmost importance that this PCO be processed quickly. Our industry is currently having supply issues. The cost of material is on a consistent rise and it is not as readily available, with lead times getting longer. This may directly impact your project. BMY is working diligently to process requested changes quickly, keep material pricing down and get material and products. At this time we need your assistance with timely approvals so we can minimize project impacts. We appreciate your assistance with this matter. If you have any questions or need any further information, please do not hesitate to contact me. Respectfully, Dylan Medeiros Superintendent Page 1 of 1 5485 East Olive Avenue • Fresno, CA 93727 • Phone (559) 243-4200 • Fax (559) 222-2380 Lic No. 686178 PCO #029 CONSTRUCTION GROUP INCORPORATED BMY Construction Group Incorporated Project:21008-Environmental Compliance Center-Contract#20-S-01 5485 East Olive Avenue 310 S.West Ave Fresno,California 93727-2541 Fresno,California 93706 Phone:(559)243-4200 Fax:null Prime Contract Potential Change Order #029: CE #047 - ADA Concrete Walk TO: The County of Fresno, Department of Public FROM: BMY Construction Group, Inc. Works and Planning 5485 E.Olive Ave 2220 Tulare Street,8th Floor Fresno,California 93727 Fresno,California 93721 PCO NUMBER/REVISION: 029/0 CONTRACT: 21008-Environmental Compliance Center-Contract#20-S-01 Prime Contract REQUEST RECEIVED FROM: CREATED BY: Nathan Womack(BMY Construction Group,Inc.) STATUS: Pending-In Review CREATED DATE: 7/20/2023 REFERENCE: PRIME CONTRACT None CHANGE ORDER: FIELD CHANGE: No LOCATION: Site ACCOUNTING METHOD: Amount Based THE REFERENCED PCO WILL EXPIRE AFTER: SCHEDULE IMPACT: PAID IN FULL: No EXECUTED: No SIGNED CHANGE ORDER RECEIVED DATE: TOTAL AMOUNT: $7,348.10 POTENTIAL CHANGE ORDER TITLE:CE#047-ADA Concrete Walk CHANGE REASON:Client Request POTENTIAL CHANGE ORDER DESCRIPTION: (The Contract Is Changed As Follows) CE#047-ADA Concrete Walk ATTACHMENTS: ECC Self Performed Concrete.pdf # Budget Code Description Amount 1 50-0005.0 HSS&Purlin Change after Bid.Other ADA Concrete Walk $6,581.00 Subtotal: $6,581.00 Project Manager(2.90%Applies to all line item types.): $190.85 General Liability(0.10%Applies to all line item types.): $6.58 Superintendent(2.00%Applies to all line item types.): $131.62 Project Engineer(1.50%Applies to all line item types.): $98.72 Overhead and Profit(3.50%Applies to all line item types.): $230.34 Health Insurance(0.75%Applies to all line item types.): $54.29 Bond(0.75%Applies to all line item types.): $54.70 Grand Total: $7,348.10 BMY Construction Group Incorporated Page 1 of 2 Printed On:7/20/2023 09:26 AM = PCO #029 CONSTRUCTION GROUPINCORPORATED Erin Haagenson(The County of Fresno, The County of Fresno,Department of BMY Construction Group,Inc. Department of Public Works and Public Works and Planning Planning) 2220 Tulare Street,6th Floor 2220 Tulare Street,8th Floor 5485 E.Olive Ave Fresno,California 93721 Fresno,California 93721 Fresno,California 93727 SIGNATURE DATE SIGNATURE DATE SIGNATURE DATE BMY Construction Group Incorporated Page 2 of 2 Printed On:7/20/2023 09:26 AM BMY CONSTRUCTION GROUP INC. BMY Job Number PCO Description: _ PCO 9: 1 Date: MATERIAL Description TUnits Unit Price Subtotal Concrete CY shortload 4.00 275.00 1,100.00 0.00 0.00' 0.00 0.00 0.00 0.00 _ Subtotal 1100.00 Sales Tax(7.98%) 87.78 Shipping/Freight _ Overhead &Profit 10% 118.78 Total Material $1,306.56 EQUIPMENT Descri tion I Units Unit Price Subtotal Foreman truck 2.00 250.001 500.00 _ tools/forms/stakes 1.00 300.001 1 300.00 0.00 _ _ _ Subtotal 800.00 j Overhead & Profit 10% 80.00 Total Equipment $880.00 LABOR Description M/Hr Cost/MH MD I Labor Burden Subtotal Cement Mason 24.00 74.94 3 25.41 2408.40 Laborer 12.00 69.69 1.5 24.14 1125.96 Carpenter 4.00 86.76 0.5 28.28 460.16 Iron Worker _ 0.00 85.390 0 27.95 0.00 0.00 0.00 3994.52 Overhead &Profit 10% 399.45 Total Labor $4,393.97 Subcontractors Subcontractors I Description Units Unit Price I I Other Cost I Subtotal 0.00 L 0.00 0.00 0.00 0.00 0.00 Subtotal Subs 0.00 Overhead &Profit 10% 0.00 Total Subcontractors $0.00 TOTAL Subtotal 6,580.53 � 1 TOTAL $6,581 TIME EXTENSION REQUIREMENT= 0 Calendar Days f CONSTRUCTION GROUP INCORPORATED July 20, 2023 County of Fresno Construction Division Attn: Keith Eckert 2220 Tulare Street, 711 Floor Fresno, CA 93721 Re: Environmental Compliance Center BMY JOB NO. 21008 Subject: PCO#30—T&M Tesco Panel Mr. Eckert, BMY Construction Group, Inc. (BMY) is providing the following PCO for the costs and time associated with the changes made to site street lighting.Tesco panel feed supplied on a T&M basis per County direction. BMY is requesting the County to issue a Change Order adding $51,763.29 to the contract price. In order to perform the work BMY is requiring a time extension of 0 calendar days. This PCO is valid for 30 days. Due to unprecedent times in our industry, with volatile material pricing and delivery, it is of the utmost importance that this PCO be processed quickly. Our industry is currently having supply issues. The cost of material is on a consistent rise and it is not as readily available, with lead times getting longer. This may directly impact your project. BMY is working diligently to process requested changes quickly, keep material pricing down and get material and products. At this time we need your assistance with timely approvals so we can minimize project impacts. We appreciate your assistance with this matter. If you have any questions or need any further information, please do not hesitate to contact me. Respectfully, Dylan Medeiros Project Engineer Page 1 of 1 5485 East Olive Avenue • Fresno, CA 93727 - Phone (559) 243-4200 • Fax (559) 222-2380 Lic No. 686178 = PCO #030 CONSTRUCTION GROUP INCORPORATED BMY Construction Group Incorporated Project:21008-Environmental Compliance Center-Contract#20-S-01 5485 East Olive Avenue 310 S.West Ave Fresno,California 93727-2541 Fresno,California 93706 Phone:(559)243-4200 Fax:null Prime Contract Potential Change Order #030: CE #048 - T&M Tesco PG&E Feed TO: The County of Fresno, Department of Public FROM: BMY Construction Group, Inc. Works and Planning 5485 E.Olive Ave 2220 Tulare Street,8th Floor Fresno,California 93727 Fresno,California 93721 PCO NUMBER/REVISION: 030/0 CONTRACT: 21008-Environmental Compliance Center-Contract#20-S-01 Prime Contract REQUEST RECEIVED FROM: CREATED BY: Dylan Medeiros(BMY Construction Group,Inc.) STATUS: Pending-In Review CREATED DATE: 7/24/2023 REFERENCE: PRIME CONTRACT None CHANGE ORDER: FIELD CHANGE: No LOCATION: ACCOUNTING METHOD: Amount Based THE REFERENCED PCO WILL EXPIRE AFTER: SCHEDULE IMPACT: PAID IN FULL: No EXECUTED: No SIGNED CHANGE ORDER RECEIVED DATE: TOTAL AMOUNT: $51,763.29 POTENTIAL CHANGE ORDER TITLE: CE#048-T&M Tesco PG&E Feed CHANGE REASON: Design Development POTENTIAL CHANGE ORDER DESCRIPTION: (The Contract Is Changed As Follows) CE#048-T&M Tesco PG&E Feed Directed to proceed on T&M to supply feed for Tesco Panel ATTACHMENTS: PCO Cover Letter#30.pdf, _PCO#30-Package.pdf,_FW 21008 ECC-Street Light.msg ,_Re 21008 ECC-Street Light.msg , _Westech Cost.pdf # Budget Code Description Amount 1 26-0500.PO Electrical/WESTECH.Purchase Order Feed for Tesco panel $46,359.54 Subtotal: $46,359.54 Project Manager(2.90%Applies to all line item types.): $1,344.43 General Liability(0.10%Applies to all line item types.): $46.36 Superintendent(2.00%Applies to all line item types.): $927.19 Project Engineer(1.50%Applies to all line item types.): $695.39 Overhead and Profit(3.50%Applies to all line item types.): $1,622.58 Health Insurance(0.75%Applies to all line item types.): $382.47 Bond(0.75%Applies to all line item types.): $385.33 Grand Total: $51,763.29 BMY Construction Group Incorporated Page 1 of 2 Printed On:7/24/2023 09:52 AM PCO #030 CONSTRUCTION GROUPINCORPORATED Erin Haagenson(The County of Fresno, The County of Fresno,Department of BMY Construction Group,Inc. Department of Public Works and Public Works and Planning Planning) 2220 Tulare Street,6th Floor 2220 Tulare Street,8th Floor 5485 E.Olive Ave Fresno,California 93721 Fresno,California 93721 Fresno,California 93727 SIGNATURE DATE SIGNATURE DATE SIGNATURE DATE BMY Construction Group Incorporated Page 2 of 2 Printed On:7/24/2023 09:52 AM VWELECTRICAL CONTRACTORS CONT.LIC:VO 1072735 C-10 7/14/2023 Project: 21132 - Fresno County Envirnmental Compliance Center Change Order: 06 RFI/RFP: Description: Conduit to feed the tesco panel that was shown on plans to be existing Material Items Quantity Unit Cost Material Labor Units Labor Material/Labor 1 $ 16,650.00 $ 16,650.00 15708.00 $ 15,708.00 $ - $ - Credit Items Quantity Unit Cost Material Labor Units Labor Totals $ 16,650.00 $ 15,708.00 Sub Contractor Material Labor P/O Asphalt by Dezign 6800 $ 6,800.00 Totals $ 6,800.00 Equipment Cost Delivery Fuel Totals $ - Material $ 16,650.00 Labor $ 15,708.00 (Inside Wireman =00.00 hours at 95.00 per hour) Subcontractor $ 6,800.00 Equipment $ - Time Extention days:0 Sub Total $ 39,158.00 Overhead @ 10% $ 3,915.80 Profit @ 5% $ 1,957.90 Tax @ 7.975% $ 1,327.84 Tota I Cost: $ 46,359.54 Notes: See attached material breakouts,T&M Sheets and Asphalt Dezign invoice Exclusion: 827 Jefferson Ave Clovis Ca 93612 Lic#1072735 - Ph #559-455-1720 WESTECH SYSTEMS, LLC ELECTRICAL CONTRACTORS CONT. LIC. NO. 1072735 827 JEFFERSON AVE. ICO#06 CLOVIS, CA. 93612 TEL.: (559)455-1720 IPAGE 2 OF 2 FAX.: (559)455-0952 PROJECT: 21132 - FRESNO COUNTY ENVIRONMENTAL COMPLIANCE CENTER -TESCO PANEL FEED MATERIAL/LABOR BREAKDOWN (SITE -CONDUIT CHANGES FOR STREET LIGHTS 235 2" GRC 22.50 5288 0 0 4 2" SWEEP GRC 30.00 120 0 0 3 10 MILL TAPE 30.00 90 0 0 235 CONCRETE TRENCH 7.50 1763 0 0 4 CONCRETE COLLARS 175.00 700 0 0 50 SAWCUT 20.00 1000 0 0 2 TRENCH PLATES 185.00 370 0 0 8 MINI EX 310.00 2480 0 0 6 SKID STEER 360.00 2160 0 0 7 226 TRUCK 250.00 1750 0 0 1 DUMP TRUCK 250.00 250 0 0 2 JACK HAMMER 90.00 180 0 0 1 WACKER 125.00 125 0 0 3 COLD PATCH 35.00 105 0 0 9 BAGS OF GROUT 30.00 270 0 0 187 LABOR 0.00 0 84 15708 0 LABOR- OT 0.00 0 127 0 0.00 0 0 0 16650 15708 INCLUSIONS EXCLUSIONS - MATERIAL AND LABOR AS LISTED ABOVE -ANYTHING NOT LISTED ABOVE c� R Z R, �Irk W N m ,1\ > 0 c = 3 cn 0 0 � O 3 00 a� UJ m : J (NI y � A 3 � z e � � rn m � O � � 1 D ry a r r z r � � m o z o n v w rn 0 W C� O rn rn ° o x \ Z q ►� kA LA - N rn ° G � 0 � c or rn o 0 3 v Ll 1 o p n W Ll 03 10 O � A � D x A o n M D r v z ` O � 3 � C o m D O n z rn 3 0 O O � -o z 1 m \ � � � m A H 0 � A 3D °z D � z m H c 0 m m m _ : a L H 0 � °� 0 AD n r o m X � � D o z � O 3 u 'C O 0 rn -a m ~ � "n rn rn � � N z O n 0 Z m n N ul c = rn rn N O O = 14 rn r r �n ' r � D O r n z o \ m 70 H D W 'O V m 71 � m H o � n 0 m mrA rn � i ° � a 0 O = 1� 0 c D -i N a r 41D � o z 1 � 3 t1� Z O � 3 � � v o p "{ rn z o Cl rn o x Ilk cn = c � G O H r r, O o 0 3 v rn 0 v 3 0 TA n 2 � K y rn N N v �o 0 3 PG. O p O o m � O � c � � O � 3 v 01 v 0 IZI, m r!�l rn m \ � R N 3 o t J J o N � � G G c 0 3 v m � v lam• N Z 03 s o o 0 r� 3 10 F' rnG o p rn N r' � z O s O � 3 1 � w o F � z y U 3 r � crnn � aS � z O 0 3 o 0 V �� m v O � o rn = AJ vJ l � o ` rn � 3 K a 0 z � � c o 1, P ASPHALT DESIGN BY JUAN GOMEZ Invoice 4061 W. BELMONT AVENUE FRESNO, CA 93722 Creation Date Invoice# (559) 276-0447 FAX (559)276-8029 5/30l2023 5364 Bill To Westech Systems,LLC 827 Jefferson Ave. Clovis,CA 93612 Description Invoice Date Purchase Order Project (PW)Fresno 6/7/2023 Shelley West Ave.-Fresno(P... Quantity Description Rate Amount 1 (PW)Trench patching needed at Environmental Compliance Center located at 6,800.00 6,800.00 310 S. West Ave.-Fresno,CA 93706(Nielsen&Marks);started on 5/30/2023 &completed on 6/7/2023. BID DATE:5/1/2023 (SK) 1.Patch back 7"of asphalt in trench 44'x 2'.Stripe 33'of double yellow line. Westech to remove trench plates. 0 NOT NEEDED-Additional$1,700.00 if we have to T-cut the trench 0.00 0.00 It is always a pleasure working with you! Total $6,800.00 Payments/Credits $0.00 Thank you for your business! Balance Due $6,800.00 CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. Identifying Information Name of Claimant: Asphalt Design by Juan Gomez Name of Customer: Westech Systems, LLC Job Name: West Ave. — Fresno (PW) 5/2023 Environmental Compliance Center Job Location: 310 S. West Ave. - Fresno. CA 93706 Owner: The County of FresnoDepartment of Public Works & Planning Conditional Waiver and Release This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job. Rights based upon labor or services provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this Document is signed by the claimant, are waived and released by this document, unless listed as an Exception below. This document is effective only on the claimant's receipt of payment from the financial institution on which the following check is drawn.- Maker of Check: Westech Systems, LLC Amount of Check: $6,800.00 Check Payable to: Asphalt Design by Juan Gomez Exceptions This document does not affect any of the following: Disputed claims for extras in the amount of: $ Signature Claimant's Signature: J_ Claimant's Title: Mministrator Date of Signature: 6/7/2023