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DEPARTMENT OF PUBLIC WORKS <br />b <br />DIVISION OF ENGINEERING <br />46A <br />Project Number: 118-003R Project Name: JMS Building: Parking Lot Improvements Change Order #: 1 <br />DATE INITIATED:4/16/19 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Install additional concrete sidewalk and remove and replace concrete collar around existing storm <br />drain casting. <br />Attachments: (List documents support change — required) <br />.......... .... <br />Amount of BIncrease / ❑ Decrease: $• 1150.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $� <br />❑ Scope of Work <br />----•- ®Differing Site Conditions, Changed Conditions <br />Current Percent of Change: '36 % ❑ Conflicted Specifications and Drawings <br />85 <br />New TotaLAmount: ,831.00 <br />�El Failed Materials <br />❑ Error <br />❑ Omission <br />Total Percent of Change: 1-36 % ❑ Final Quantity Adjustment <br />.. � ....._ <br />Funding Secured ._..., .,.- A, . , .... <br />From: <br />River West TIF ° <br />RECOMMENDED BY: <br />Josh Ehmer 5/7/19 <br />dw.a t4npV J.tYS ru,,.PrdaYC <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />Ick <br />Construction Maana er Print Na — <br />( me) (Signature) � (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signs ) (Date) <br />APPROVED BY: <br />IJMiW,a�, W e <br />q- IT L <br />City Engineer (Print Name (Signal ) (Date) <br />