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DATE: <br />PROJECT NO: <br />PROJECT NAME: <br />iF'OU Tu qF <br />CITY OF SOUTH BEND <br />J i <br />DEPARTMENT OF PUBLIC WORKS <br />PROJECT CHANGE ORDER <br />01-24-2017 <br />115-129B <br />Potawatomi Zoo Parking Lot Striping <br />CONTRACT DATE: 1', 3-2016 <br />CHANGE ORDER NO. 1 <br />SUBJECT OF CHANGE ORDER: Time extension for inclement weather <br />All items completed substantially as planned. <br />See attached Comparison of Estimate for overruns and underruns. <br />The original contract sum $ 4,598.75 <br />Net change by previously authorized change orders $ 0.00 <br />The contract sum prior to this change order $ 4,598.75 <br />By this Change Order, the project amount is ❑ Increased <br />The new contract sum including this change order <br />This Change Order represents a total change of <br />Total change for entire project <br />vnginai contractea compietion Gate/time <br />Extension of date/time by previous change orders <br />Date/time extension by this change order <br />New completion date/time <br />CONTRACTOR <br />Contractor Signature <br />❑ Decreased $ 0.00 <br />$ 4,598.75 <br />0.00 % <br />0.00 % <br />RECOMMENDED FOR APPROVAL <br />Project Manager <br />CITY OF SOUTH BEND <br />BOARD OF PUBLIC WORKS <br />Approved Date: / ,z c11 z ) j <br />Printed Name and Title Gary A.,Gilot, President <br />DBL Services Inc. <br />Company name <br />1811 N. Clover Rd. <br />Address <br />Mishawaka, IN.46545 <br />City, State, Zip <br />Member <br />Therese J-DorEU, Merhber <br />Ja s A. Mueller, Member <br />�1 <br />Suzanna M. Fri ber7, Membe <br />