Contract Change Form, WTC AMC Monitoring, 2003

NYC 9/11 Public Portal Document

CONTRACT CHANGE DEP Form 409N

+°tK ~'"'et CONTRACT AND CONTRACT CHANGE NUMBER

DP WTC Indoor Dust Cleaning Program C.O. I

COMPTROLLER'S REGISTRATION NUMBER CT 826 20030010692

BUDGET LINE CONTRACT ID and DESCRIPTION B.C. W005/OBJ 600 WTC-AMC Monitoring of Apts in Vicinity of WTC

CONTRACTOR'S NAME AND ADDRESS PIN FMS PROJECT ID Warren & Panzer Engineers228 East 45w' Street, 101° floor, NY. NY 10017 82603WTCIAMC 826 NA

CONTRACT AWARD AMOUNT DESIGN FIRM (if applicable)

$2,858,376 r s::F s? :,. : 0: ITEM DESCRIPTION OF WORK CONTRACTOR'S AUTHORIZED NUMBER ATTACH ADDITIONAL SHEETS IF NECESSARY PROPOSAL COST This change order Is being advanced pursuant to the Declaration of Emergency signed by Commissioner Christopher O. Ward on May 7, 2002. On May 13, 2002, written approval was provided by the Corporation Counsel, and on May 28, 2002 written approval was provided by the Comptroller.

This Change Order shall provide an administrative fee of $124.50 per apartment, an amount equal to 3 hours of Project Monitor $214,887 $214,887 time, under the same terms and conditions of the contract. This fee is limited to a maximum of 1726 apartments. The contractor shall comply with the cancellation policy Implemented by USEPA on November 26, 2002, and shall confirm appointments 24 hours in advance. -l-~ I r 5

TOTAL= Interim(If any) or Forced IN any) PLUS Final IN any) or $214,887 $214,887 Revised (if any) otherwise TOTAL = This Change Order PREVIOUS AMOUNT REGISTERED FOR THIS CHANGE (If any) 50

AMOUNT REQUIRED FOR REGISTRATION OF THIS CHANGE $214,887 1. The Contractor shall sign 4 copies of this form, and together with 4 copies of the Contractor's detailed cost proposal, send it to the Agency Contact for this Contract within seven calendar days of receipt of this proposed contract change.

2. It the total amount of the extra work (excluding credit change orders) Issued for the contract exceeds 10% of the contract amount or $100,000, whichever Is greater, or exceeds previous BOElODC1MOC Approvals, the Agency must obtain approval from the Mayor's Office of Construction or the Mayor's Office of Contracts (as applicable) In order to award extra work.

3. When a price Is agreed to between the Commissioner's authorized representative and the Contractor, and all required approvals have been obtained, the Contractor shall be Issued a contract change to proceed with the work. Contractor shall not proceed with this work until Issued a contract change or otherwise directed by the Commissioner.

4. Any payments for extra work must be requisitioned separately from payments for work required under the original contract.

5. All Construction and Construction-Related work Is subject to postaudt by the Department's Engineering Audit Officer and the Comptroller's Chief Engineer.

1) CONTRACTOR'S APPROVAL 3) DEPARTMENTS APPROVAL

Submitted above is my Cost Proposal for the This Change Is approved and the contractor/consultant Is Contract Change. Contractor hereby certifies that the directed to proceed. Payment will be made as provided cost and pricing data submitted are accurate, herein. complete and current. [ ] On a Time and Material Basis Not-to-Exceed the Authorized Con at0 s Ignature Cost [ ] On a Unit Price Basis Not-to-Exceed the Authorized.Cost At the Authorized Cost Title 1, s, or„ Date: aaaamaaaaaaameam----=aaasaaaaam aaaa Authorized Signature 2) CONTRACTOR AGREES WITH "AUTHORIZED COST' — Cont a3'ugnature ~ / ~y ~ Title:1.244/ 6 1001 ., Date' of t U (6 3

Title Date: 17 P3

Rev 11124/00 DEP FM 409N

NYC-WTC 000135164