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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 1 -074D (Div U') Project Name: Three Twenty at ft Cascade Site Uhli ses (Div B) Change Order #: � <br />DATE INITIATED: 6-13-19 <br />BPW DATE: 6-25-19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Added work includes unforeseen conditions. A section of abandoned watermain needed to be <br />removed for the sewer lateral as well as two old foundation walls that were in the path of the sewer <br />lateral. <br />Attachments: (List documents support change — required) <br />Price breakdown <br />Amount of BIncrease / ❑ Decrease: $ 2, 063.50 <br />................................ <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0.00 <br />❑ Scope of Work <br />____..... <br />4'01 <br />B Differing Site Conditions, Changed Conditions <br />Current Percent of Change: % <br />❑ Conflicted Specifications and Drawings <br />New Total A__ .............. <br />53 487.00 <br />Amount: $ ' <br />� ❑Failed Materials <br />❑ Error <br />4.0 1 <br />❑Omission <br />Total Percent of Change: <br />❑ Final Quantity Adjustment <br />Funding Secured From: <br />E <br />(filled out by PM) <br />RECOMMENDED BY: <br />Dan Jones <br />.f .: (�._ 3 - / <br />Project Inspector (Print Name) <br />(Signature) _ (Date) <br />REVIEWED BY: <br />` <br />Toy Villa <br />.......... _.......- �._ <br />Construction Manager (Print Name) <br />(Signature) (Date) <br />APPROVED BY: <br />Zach Hurst <br />Engineering Project Manager (Print Name) <br />(Signature) (Date) <br />APPROVED BY: <br />Kara Boyles <br />w .,,+ <br />City Engineer (Print Name) <br />(Signature (Date) <br />