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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />11W <br />118-086R Liberty Tower Improvements DivC 1 <br />Project Number: Project Name:. .Change Order #: <br />DATE INITIATED. 6/12/19 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Changes per owner Direction. <br />Attachments: (List documents support change — required) <br />Contractors cost. <br />. ... _M ... ....... .................. <br />Amount of ❑ Increase / BDecrease: $ 4227.32 <br />............... ....... ......... ................................ Categories (Pick One): <br />Previously approved Change Order(s): $ 0 ® Scope of Work <br />Current Percent of Change: -1 '39 <br />El Differing Site Conditions, Changed Conditions <br />......... — . % ❑ Conflicted Specifications and Drawings <br />299772.68 IDFailed Materials <br />New Total Amount: $.._ .......................................... _ _ ❑ Error <br />❑ Omission <br />Total Percent of Change: 1 39 IT,,,,ITITITIT_ % ❑ Final Quantity Adjustment <br />El <br />Funding Secured From <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer 6/18/19 <br />Project Inspector (Print Name) (Signal a (Date) <br />REVIEWED BY: <br />....... ........ e <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />. S_,Ivegs 4624k <br />Engirt ing Project Manager (Print Name) (Signat ) (Date) <br />APPROVED BY: <br />A�a I es Ili 131 <br />City Engineer (Print Name) ig at (Dale <br />