Change Order No. 1PROJECT:
SUBJECT:
DATE:
SPONSER:
CONTRACTOR:
ENGINEER:
ORIGINAL CONTRACT PRICE
AS BID (Schedules A, B, C & D):
NET INCREASE/DECREASE
RESULTING FROM PRIOR
APPROVED CHANGE ORDERS
OR SUPPLEMENTAL AGREEMENTS:
CONTRACT PRICE PRIOR TO
THIS CHANGE ORDER NO. 1:
NET INCREASE/BEGREASE
RESULTING FROM THIS
CHANGE ORDER NO. 1:
NEW CONTRACT PRICE INCLUDING
THIS CHANGE ORDER NO. 1:
CONTRACT TIME PRIOR TO
THIS CHANGE ORDER NO. 1:
NET INCREASE;cr
^•-�•�°.EASEE
RESULTING FROM THIS
CHANGE ORDER NO. 1:
NEW CONTRACT TIME
INCLUDING THIS C.O. #1:
DESCRIPTION OF WORK
COVERED BY THIS CHANGE
ORDER NO. 1:
RE: MARATHON AIRPORT
"Sealcoat Exist. G/A Aircraft Parking
Apron - Eastside
Const. New G/A Aircraft Parking Apron -
Westside
Const. 200' Blast Pads and Stabilized
Safety Areas"
FAA AIP Proj. No. 3-12-0044-0788
FDOT WPI Proj. Nos. 6826639, 6826691,
6826650
Engineer's Proj. No. 01-476.10
Change Order No. 1
February 13, 1990
Board of County Commissioners of
Monroe county, Florida
General Asphalt Company, Inc.
P.O. Box 52-2306
Miami, Florida 33152
Post, Buckley, Schuh & Jernigan
8600 N.W. 36th Street
Miami, Florida 33166-6622
$811,443.50
N/A
$811,443.50
$116,869.29
$928,312.79
120 Calendar Days
+50 Calendar Days
170 Calendar Days
Elevate and regrade apron; raise existing
drainage inlet; construct 150' L.F. French
drain; add one inlet with frame and grate;
add runway marking, striping and lighting
associated with temporary threshold
relocation; substitute bituminous surface
course in lieu of surface treatment; delete
Sealcoat at new G/A apron - westside.
,le I of 4
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We the Engineers, are sending six (6) copies of this Change Order No. 1 to you,
the Contractor. Please sign and forward five (5) copies to Monroe County, c/o Mr.
Art Skelly, Director of Airports, Key West International Airport, 3491 South
Roosevelt Boulevard, Key West, Florida 33040. Mr. Skelly will obtain Monroe
County approval. Upon approval by the Federal Aviation Administration, Mr. Skelly
will notify you that this Change Order No. 1 is in effect and will make
distribution of the fully executed copies to you and other concerned parties.
SUBMITTED:
ACCEPTED:
APPROVED:
APPROVED:
m:C-53/P
POST, BUCKLEY, SCHUH & JERNIGAN
BYATE: l u. 90
Patrick J ^ebu11, Y.
GENERAL ASPHALT COMPAN Y'i INC.
BY:
ATTE
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
G
BY: TE:
T) A Ni r TrnT .T.T e r_z+ 01-7,
ATTESTED .
e
FEDERAL AVIATION ADMINISTRATION
BY: DATE:
James E. Sheppard, Mgr.
Orlando Airports District Office
Ap1N01YcDrl�t f',01��
AND LEGAL StJf 90M
my ---�---�-�---
Attorr,.y`i 000
Page 4 of 4
—OP--�
SWORN STATEMENT UNDER SECTION 257.133(3)(u),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER
AUTHORIZED TO ADMINISTER OATHS. FAA AIP Project No.
1. This sworn statement is submitted with Bid, Proposal or Contract No. 3-12-0044-0788
for Marathon Airport - Airfield Irrprovemnts, Marathon, Florida
2. This sworn statement is submitted by General Asphalt Corrpany, Inc.
[name of entity submitting sworn statement]
whose business address is
4850 Northwest 72nd Avenue
Miami, Florida 33166 and
(if applicable) its Federal Employer Identification Number (FEIN) is 59-1115297
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement: N/A - )
My name is Royal S, Webster, Jr. and r„v relationship to the
[please print name of individual slgningj
entity named above is Vice President
4. I understand that a 'public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes.
means a violation of any state or- federal law by a person with respect to and directly related to the
transaction of business with any public entity or with an agency or political subdivision of any other
state or with the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state
or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
S. I understand that "convicted" or "conviction' as defined in Paragraph 287.133(1)(b), Florida Statutesl
means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of
guilt, in any federal or state trial court of record relating to charges brought by indictment or
information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty
or nolo contendere.
6. I understand that an 'affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:
1. A predecessor or successor of a person convicted of a public entity crime: or
2. An entity under the control of any natural person who is active in the management of the
entity and who has been convicted of a public entity crime. The term 'affiliate' includes those
officers. directors. executives, nartners, s�2r�!+o!�+�r`, employees, r.:em,=, and sg--ts who are active
in the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
market value under an arm's length agreement, shall be a prima facie case that one person controls
another person. A person who knowingly enters into a joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months shall be considered an
affiliate.
7. a understand that a 'person' as defined in Paragraph 287.133(1)(e), Florida Statutes means any
natural person or entity organized under the laws of any state or of the United States with the legal
power to enter into a binding contract and which bids or applies to bid on contracts for the provision
Of goods or services let by a public entity, or which otherwise transacts or applies to transact business
with a public -entity. The term 'person' includes those officers, directors, executives, partners,
shareholders. employees, members, and agents who are active in management of an entity.
& Based on information and belief, the statement which I have marked below is true in relation to the
entity submitting this sworn statement. [Please Indicate which statement applies.]
XXX Neither the entity submitting this sworn statement, nor any officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in management of the entity,
nor any affiliate of the entity have been charged with and convicted of a public entity crime
subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of the officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in management of
the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 1989, AND [Please Indicate which additional statement applies.]
There has been a proceeding concerning the conviction before a hearing officer of
the State of Florida, Division of Administrative Hearings. The final order entered by the
hearing officer did not place the person or affiliate on the convicted vendor list. [Please
attach a copy of the final order.]
The person or affiliate was placed on the convicted vendor list. There has been a
subsequent proceeding before a hearing officer of the State of Florida, Division of
Administrative Hearings. The final order entered by the heating officer determined that it
was in the public interest to remove the person or affiliate from the convicted vendor list.
[Please attach a copy of the final order.]
_ The person or affiliate has not been placed on the convicted vendor list. [Please
dei'cribe any action taken by or pending with the Department of General Services.)
[signature]
Date: February 281 1990
STATE OF
FLORIDA
COUNTY OF DADE
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Royal S. Webster, Jr. , Vice Pres . who, after first being sworn by me, affixed his/her signature
[name of Individual signing]
in the space provided above on this 28th day of Februa> y, i9 90
My commission expires:
my Do- 26, 1.;32
For: t PUR 7068 (Rev. 11/89)