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0iy444' <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />4l�pM � <br />1 1 8-074D IWoo Tworily°a tho C: N° +a" P IUtWtigm (101 m ionA P C ) 2 <br />Project Number: Project Name: Change Order #: <br />DATE INITIATED. 4-15-19 BPW DATE: 5-28-19 mmmmmmmmm <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Includes deductions for eliminating structures as well as additions for replacing frozen subgrade <br />and demo of unforeseen existing foundations in the watermain path. <br />Attachments: (List documents support change — required) <br />Price breakdown <br />Amount of Blncrease / ❑Decrease: $ 2,416.00 <br />-�'"" "" Categories (Pick One): <br />Previously approved Change Order(s): $_18,295.00 ❑ Scope of Work <br />IT Iii Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 129 <br />❑ Conflicted Specifications and Drawings <br />189,183 ❑Failed Materials <br />New Total Amount: $ ❑ Error <br />nnnn12.29 ❑Omission <br />Total Percent of Change: __.... % ❑ Final Quantity Adjustment <br />Funding Secured From: River <br />(filled out by PM) <br />RECOMMENDED BY: <br />Dan Jones <br />M <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />Toy Villa <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Zach Hurst <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Kara Boyles <br />City Engineer (Print Name) (Signatur) (Date) <br />