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47"„„90 CIY�0�:r4 <br />'^ DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 1 17-127R Project Name: sBFD Training center classroom Building Change Order #: 1 <br />DATE INITIATED; 5-3-19 <br />BPW DATE: 5-14-19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Various deletions and additions, most notably partition motor deduct, HVAC mixing box deduct, <br />and added floor conduits; 20 day time extension for added work <br />Attachments: (List documents support change — required) <br />Breakdown of added items <br />............... _M .. <br />Amount of BIncrease/ ❑ Decrease: $ 2,151.00 <br />_ ......._ ............-.. <br />- .................. <br />. . Categories (Pick One): <br />Previously approved Change Order(s): $ 0.00 <br />I@ Scope of Work <br />... <br />Current Percent of Change: 0'33 <br />❑ Differing Site Conditions, Changed Conditions <br />_ n...... <br />❑ Conflicted Specifications and Drawings <br />652,088.00 <br />New Total Amount: $ <br />❑Failed Materials <br />❑ Error <br />__ ...................... ............. _ <br />0.33 <br />El Omission <br />Total Percent of Change <br />❑ Final Quantity Adjustment <br />Funding Secured From <br />(filled out by PM) <br />RECOMMENDED BY: <br />Dan Jones <br />Project Inspector (Print Name) <br />(Signature) (Date) <br />REVIEWED BY: <br />Toy Villa _...... <br />Construction Manager (Print Name) <br />_... ...... <br />(Signature) (Date) <br />APPROVED BY: <br />Alicia Czarnecki <br />-LfJA <br />ko"Z, <br />Engineering Project Manager (Print Name) <br />(Signature) (Date) <br />APPROVED BY: <br />Kara Boyles <br />City Engineer (Print Name) <br />(Signature) (Date) <br />