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CONTRACT NO. R 3�88'1 <br />NOTE: Upon request from Engineer, enter detailed description on page 2. <br />DATE OF SUBMISSION ,luly. 2t3�:8 <br />ONSET DATE OF CHANGEMI3�38. CHANGE ORDER TYPE t0�1 Ci3 Exrra Woii< <br />PROPOSED COST AND TIME ADJUSTMENT <br />COST <br />COST INCREASE / (DECREASE): <br />$ 2629J. 03 <br />The cost adjustment shall include lump sum and estimated totaled unit -priced item costs. Attach a separate sheet of unit price items <br />including item description, unit of measurement, estimated quantity and unit price. <br />CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF COST CHANGE: <br />0.349.03 P ltered Quantities ©109 05(a)Agree0rICE :1D9 D5(b} Force.Account Ci 1D9,A5.02 Delay Costs. <br />PROPOSED COST CHANGE INCLUDES: ®, ! abor ';© Material `U Equip:rn fit f� Lease Agreement . E <br />Subcontractor <br />TIME ADJUSTMENT <br />INCREASE / (DECREASE): <br />CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: <br />(work days) 44. <br />® 108.08(a) Excusable; Nan-Conipensable 0.108.0$(bJ Excusable; .Compensable <br />NOTE: If Compensable, attach details based on 109.05.2(a) Allowable relay Costs. <br />Additional intormatlon may be entered by the contractor. <br />Ver. 10.23.17 <br />