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'.Kr,4:. P7i &Y'. <br />tDEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />INOA , <br />1 8-0 F 2 (Div 13 � McKinley Avenue and Fremont Park Improvements (Div B) <br />Project Number: Project Name:. Change Order #: <br />DATE INITIATED: 6-13-19 BPW DATE.: 7-9-19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />VPA and Engineering wanted to test out a new product; Trip Stop. This was placed at every <br />contraction joint around the memorial tree (5ft * 23 joints = 115 LFT)) <br />Attachments: (List documents support change — required) <br />N/A <br />Amount of Blncrease / ❑Decrease: $ 1 ,380.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0.00 — ® Scope of Work <br />......................_--- El Differing Site Conditions, Changed Conditions <br />Current Percent of Changer 0'56 % ❑ Conflicted Specifications and Drawings <br />245,950 00 ❑ Failed Materials <br />New Total Amount: $ _ ❑ Error <br />0.56 I--] Omission <br />Total Percent of Change: , % ❑ Final Quantity Adjustment <br />El <br />Funding Secured From: _ ,,,,,, "OilIr <br />(filled out by PM) <br />RECOMMENDED BY <br />.. <br />Dan Jones <br />Project Inspector (Print Name) (Signattre) (Date) <br />REVIEWED BY: <br />Toy Villa <br />Construction Manager (Print Name) (Signature) _ (Date) <br />APPROVED BY: <br />Alicia Czarnecki <br />Engineering Project Manager (Print Name) (Signature) 0 (Date) <br />APPROVED BY: <br />Kara Boyles <br />City Engineer (Print Name) (SiCi)a ) (DI <br />