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X.y,ARt Mld 4'Sl <br />a,. <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 1 16-012 Project Name: Fire Station #9 Change Order #: 5 <br />DATE INITIATED:5-1-19 � �BPW DATE:5-14-19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />14 day time extension for winter weather delays; Credit for removing truck fill line and add to <br />provide and install duct. <br />Attachments: (List documents support change - required) <br />AIA G701 <br />Amount of ❑ Increase / iRDecrease: $ 553.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $.•-7, 398.00 ® Scope of Work <br />.. ----- ................... - ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: -0.02 __ __ <br />❑ Conflicted Specifications and Drawings <br />— <br />❑ Failed Materials <br />New Total Amount: $ 3,644,549.00 <br />❑ Error <br />. ........ w.W_. <br />❑ Omission <br />Total Percent of Change: -0.22 <br />❑ Final Quantity Adjustment <br />Funding Secured From: <br />(filled out by PM) <br />RECOMMENDED BY: <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />119 <br />......: <br />Construction M g r (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />City Engineer (Print Name) (Statre) (Date) <br />