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CONTRACT NO. R=3$81 <br />NOTE: Upon request from Engineer, enter detailed description on page 2. <br />DATE OF SUBMISSION JuBy 2 20I8 <br />ONSET DATE OF CHANGE June::I4 2tJ 4 8` CHANGE ORDER TYPE 1Q�} t33 Extra Work <br />PROPOSED cou AND TIME ADJUSTMENT <br />COST COST INCREASE / (DECREASE): $ Ez2i50 00 <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 />❑ 109.03 Altered Quant.it'te.s '. ® 109.05(a) Agreed Price ❑.109 05('b) Force Account ❑ s 109.05.02.Delay Costs <br />PROPOSED COST CHANGE INCLUDES: © Labor `© Material ' ❑:Equ�ent .❑ Lease Agreement S <br />Subcontractor <br />TIME ADJUSTMENT INCREASE / (DECREASE): (work days) i <br />CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: <br />® 108.08(a) EXcusable; Non-Compe;nsabke Ci 108.Q8(i.. xcusa.ble, Gompensable. <br />NOTE: If Compensable, attach details based on .109.05.2(a) Allowable Delay Costs, <br />SUPPLEMENTAL INFORMATION <br />Ver. 10,23.17 <br />