Change Order - UBD Inc. - 2024-10-17COSTA MESA SANITARY DISTRICT
Project Name:
Project No.
REQUEST FOR CHANGE ORDER
(Payment or Time)
RCO No.
DATE:
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.)
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.
Contractor:
Submitted by:
Name:
District:
Construction Manager's Approval: Engineer's Approval:
By: By:
NOTE:
Approval of this request for change order is only effective upon District approval of the change order.
Change Order approved/denied by:
10/18/24
Change oredr amount is $2700. See the attached.
Yuri Ubeda
loaded to low boy and clean the area to allow lead workers to perform lead abatement.
We are requesting one additional day to set up the dumpster, pick up the inert materials,
The concrete is obstructing the work area to perform lead abatement.
We have attached a picture of the concrete pile as a form of exhibit.
Inside the Hitchcrafter building by District employees.
UBD Inc., is requesting a change order to clean up and dispose concrete pile that was placed
10/3/24
01
Digitally signed by Mark Esquer, P.E.
DN: C=US, E=mesquer@cmsdca.gov, O=Costa Mesa, OU=District Engineer, CN="Mark Esquer,
P.E."Reason: I attest to the accuracy and integrity of
this document
Date: 2024.11.19 13:03:43-08'00'
Docusign Envelope ID: 00A9A8BE-971A-47E4-B7FD-53FAEF8E6822
UBD INC
6707 CAMELLIA AVE #205., NORTH HOLLYWOOD, CA 91606
LICENSE NUMBER 1040819, C21
1
UBD INC
Phone: (818) 482-8014
Email: ubdinc@yahoo.com
ubdincdemolitionservices.com
October 17, 2024
Job Location: 2252 Fairview Road
Costa Mesa, CA 92627
Attention: Michael Benesh
Ojai Unified School District
290 Paularino Ave
Costa Mesa, CA 92627
Change Order #1: Clean up Pile of Hitch crafter Building
Scope of work:
1. One mobilization to furnish below stated scope.
2. Prevailing wage rates.
3. Remove and dispose existing pile of concrete inside hitchcrafter building.
Change Order 1 Cost: $2,700.00
General Inclusion: The above listed quote includes not removing the trash enclosure walls.
General Exclusion: Any other item or scope not included in above listed scope of work.
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
Yuri Ubeda-President-10/17/24
Name/Signature & Title Date UBD Representative Date
Thank you for permitting us in participating in this valuable project. Feel free to contact us with any inquiry pertaining to
the scope of work.
Attentively,
Yuri Ubeda
President
Docusign Envelope ID: 00A9A8BE-971A-47E4-B7FD-53FAEF8E6822