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v � <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />11 5-143A Main & orltax Parking Structure Repairs 019 1 <br />Project Number: Project Name: Change Order #: <br />DATE INITIATED: 5/8/2019 BPW DATE:5/28/2019m <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Unforeseen post tension construction change requiring more time. Extending contract from 56 <br />days to 70 days from NTP. <br />Attachments: (List documents support change — required) <br />Main Colfax Time Extension Memo <br />Amount of ❑Increase/ ❑Decrease: $ <br />Categories (Pick One): <br />Previously approved Change Order(s): $, 0 ._._......................❑ Scope of Work <br />..�..�.._ ... . � ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: % ❑ Conflicted Specifications and Drawings <br />_....... ....... <br />El Failed Materials <br />New Total Amount: $ 866, 370.00 <br />❑ Error <br />__M ....... <br />El Omission <br />Total Percent of Change: 0 % ❑ Final Quantity Adjustment <br />Funding Secured From: <br />Parking Garage Fund and RWDA �' 14 da time extension <br />(filled out by PM) <br />RECOMMENDED B'Y:� <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: ` <br />Constructlo ager (Print Name) (Signature) (Date) <br />APPROV D <br />Enginee w 'project Manager (Print Nam) (Signature) (Date) <br />APPROVED BY: <br />City Engineer (Print Name) (Sign*re) (Date) <br />