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-�M1bw <br />ti7M,,'� <br />. " DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 118-1 01 Project Name: Century Center Site Improvements Change Order #: <br />DATE INITIATED: 5/20/1'9 mmmmmmmmmmm m � BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Change in scope: Additional concrete removal and installation <br />Attachments: (List documents support change — required) <br />PCR #001 <br />Pricing from contractor <br />Amount of B Increase / ❑ Decrease: $ 52 1 1.06 <br />.......... Categories (Pick One): <br />Previously approved Change Order(s): $,_wwwwwwwwwwwww_......... ___.....— ® Scope of Work <br />®.®®®®®®®®® ®®®®®®®®.•.___._.___ ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 3.98.................................. % ❑ Conflicted Specifications and Drawings <br />08 �❑Failed Materials <br />New Total Amount: $ ❑ Error <br />.............. _ El Omission <br />Total Percent of Change: 3.98 <br />❑ Final Quantity Adjustment <br />Funding Secured From: �'� � 0 <br />(filled out by PM) <br />RECOMMENDED BY: <br />Greg McGowan 5 - 21' \ O1 <br />Project Inspector (Print Name) (i etore,) (Date) <br />REVIEWED BY: <br />Toy Villa m <br />_ ...... ................ <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Rebecca Plantz <br />Engineering Project Manager (Print Name) (Signature) (11 De 11 le) <br />APPROVED BY: <br />Kara Boyles�,.,.� <br />City Engineer (Print Name) (Sirtt�r ti („„ (Date) <br />