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a]ANGE ORDER REQUEST FORM <br />CONTRACT NO. Rw3688') <br />UPON WRITTEN REQUEST FROM THE ENGINEER, PROVIDE ADDITIONAL. DETAIL <br />DATE RECEIVED REQUEST FOR <br />.Iuly 2; 203.8 <br />SUBMITTAL DATE OF <br />July �, �tl�.$ <br />ADDITIONAL DETAIL <br />ADDITIONAL DETAIL <br />DETAILED DESCRIPTION / JUSTIFICATION. <br />(include location(s), actions of contractor, owner, and other stakeholders, key events and related cause(s), discoveries, <br />discussions, meetings, and effect on the contract if no action is taken. Also include references to key documents attached <br />or available to support this change order request.) <br />5;days -.1 week <br />Additional road closure wil.i, make the project safer and could increase Con..tractor efficiencies thus <br />allowing the project to be completed Sooner. �LbSUQ� � .M � /"t t LC <br />PROPOSED SOLUTION — ADDITIONAL DETAILS: <br />(include proposed scope of work, means & methods, materials, equipment, utility relocation required, subcontracted <br />scope and the effect on the contract schedule, Also include references to attached documents including, but not limited <br />to, sketches, calculations, photos, material information, and submittals and meeting minutes.) <br />Should delays beyond the control of the Contractor, or. its Subcontractors, delay the project prior to. the <br />use of.this additional road closure, days will be.added to the closure congruent to additional days <br />granted on associated charige orders. <br />SIGNATURES <br />Contractor: _ <br />Name: (print) T.J ne S--b'5 5 <br />(signature) Date: <br />Project Engineer/Supervisor: (signature is to acknowledge receipt of the document and does notsignify agreement of the change order) <br />Name: (print)C YACt <br />pg. 2 <br />