Change Order - Torres Sanitation - Project 351COSTA MESA SANITARY DISTRICT
Adams Avenue Urgent Sewer Repair
Project No. 351
REQUEST FOR CHANGE ORDER
(Payment or Time)
RCO No. 1
DATE: 3/27/24
NOTICE: Conditions arising that would support a request for payment for additional work or time extension must
be brought to the District's attention within ten (10) days, and a Request for Change Order for additional work/time
extensions must be filed within fifteen (15) days. THIS FORM MUST BE USED. (See Contract Section 5.)
Circumstances supporting payment for additional work/time:
1) Describe why payment should be granted. Attach any more detailed discussion, with backup documents as
an exhibit. (Remember: damages have been contractually limited on this job. See Section 28 of the
Contract.)
Torres to backfill sewer repair trench with 1Sk Cement Slurry due to large void under asphalt.
Additional Cost $5,183.03
2) Describe the delay and why a time extension is appropriate. Provide any backup documents as may be
necessary to support the request. You must demonstrate how the critical path was impacted.
No time extension
Contractor:Torres Sanitation Systems Construction
Submitted by: Owner
Name: Alexandro Torres
District:
Construction Manager's Approval: Engineer's Approval:
By: Michael Benesh By: Mark Esquer
NOTE:
Approval of this request for change order is only effective upon District approval of the change order.
Change Order approved/denied by:
9617 OTIS ST SOUTH GATE CA. 90280
(323)518-9012
LIC# 1052723
DIR# 1000669233
Proposal
Re:
Project Title:
Project Location:
Proposal Completed By:
Description of Work:
Includes: Backfill sewer trench including large void beneath asphalt adjacent to trench with 1 Sk cement slurry.
.
Bid Item #Description Estimated QTY Unit Unit Price Total price
Co1 1.0 Sk cement slurry 10 CY LS $4,506.98
Change order Mark up +15%$676
$5,183.03
Created By:Alexandro Torres
Name and Title:Owner
Date :3/26/2024
Signature:Alex
Approved By:
Name and Title:
Date:
Signature:
TORRES SANITATION SYSTEMS CONSTRUCTION
.
SUB TOTAL
32624
Michael Benesh
Slurry Backfill
Alexandro Torres
Adams Ave Urgent Sewer Repair Project No. 351
Costa Mesa Sanitation District Costa Mesa, CA
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