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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 />4/15/2019 0:00:00 <br />116-108 <br />Erskine Clubhouse Renovation <br />9/27/2018 <br />11 <br />PCR #11-Request for Contract Time Extension <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 />ownd;z"M <br />1° - <br />Contractor Signature <br />Printed Name and,Title <br />Ziolkowski Construction, Inc. <br />Company Name <br />Address <br />City, State, Zip <br />� <br />$ <br />0.00 <br />$ <br />0. <br />Increased <br />......... <br />Decreased <br />$ <br />0.00 <br />$ <br />0.00 <br />0.00 % <br />20.35 % <br />....... <br />3/15/2019 0:00:00 <br />.... ._ <br />0 days <br />63 days <br />5/17/2019 <br />D <br />CONSTRUCTION MANAGER <br />CITY OF SOUTH BEND <br />BOARD OF PUBLIC OR S <br />Approved Date: '), xe <br />ary A. Gf0t, President <br />Genevieve E. Miller, Member <br />Elizabeth A. Maradik, Member <br />Therese J. Dorau„ Mimber <br />ler, Member <br />