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�DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 118-021A Project Name: Cleveland Well Field Refurbishments Change Order #: 2 <br />/09--....�.........°°°°°° <br />DATE INITIATED: 5/921BPW DATE: ° <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Integrate programming at North Station to receive data produced by the Cleveland Well Field, <br />Attachments: (List documents support change — required) <br />Amount of 8 Increase / ❑ Decrease: $ 4, 500.00 <br />..................................................... Categories (Pick One): <br />3 894.00 8 Sco a of work <br />Previously approved Change Order(s): $, ' P <br />.•..... ................ W--- ---- ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change 3 ........................................._ .., ,,,..— % ❑ Conflicted Specifications and Drawings <br />...New Total Amount: .......... ........_ _ w...... <br />145,244 00 El Failed Materials <br />$ ❑ Error <br />.... .._._._._. El Omission <br />Total Percent of Change: 6.13 <br />❑ Final Quantity Adjustment <br />Funding Secured From: WMyJ0 L <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer "a "A w `y'°"" 5/9/19 <br />ru nd �z ua rw u <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />1 °1 <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />a D <br />City Engineer (Print Name) (rgrrature (Date) <br />