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CITY OF SOUTH BEND, INDIANA <br />DEPARTMENT OF PUBLIC WORKS <br />PROJECT CHANGE ORDER <br />DATE: <br />PROJECT NO: <br />PROJECT NAME: <br />CONTRACT DATE: <br />CHANGE ORDER NO: <br />SUBJECT OF CHANGE ORDER: <br />NwYO « <br />12/20/2018 <br />118-107 <br />Engineering Office Im rovements <br />11 /27/2018 <br />1 <br />PCR #1-Delete Door PCR #2-New Vault Door PCR #3-Add Power <br />Outlets PCR #4-Add Ethernet Ports <br />The original contract sum <br />Net change by previously authorized change orders <br />The contract sum prior to this change order <br />By this Change Order, the project amount is <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 />Original contracted completion date/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 />Printed Name and Title <br />Ziolkowski Construction Inc. <br />Company Name <br />4050 Ral h Jones Drive <br />Address <br />South Bend„ IN, 46628 <br />City, State, Zip <br />$ <br />7,800.00 <br />$ <br />0.00 <br />$ <br />7,800.00 <br />X Increased <br />Decreased $ <br />1,433.00 <br />$ <br />9,233.00 <br />18.37 % <br />18.37 % <br />12/31 /2018 <br />0 days <br />0 days <br />12/31 /2018 <br />•TION MANAGER <br />CITY OF SOUTH BEND <br />BOARD OF PUBLIC WO KS <br />Approved Date: <br />Gary A. ilot, President <br />Suzanna M. Fr tzberg, M `mber <br />Elizabeth A. Maradik, Member <br />Therese orau, Member <br />i <br />Jarde A . lue , Member <br />f�v>� � Su111ufAv� <br />