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,9J "PMA <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 1 18-043R Project Name: V A Restroom Remodeling , Change Order #: 1 <br />DATE INITOATED: 6/20/2019 �BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Design omissions, additional/alternate materials, and unforeseen construction changes <br />Attachments: (List documents support change — required) <br />PCR #1 <br />Cost descriptions <br />Amount of B Increase / ❑ Decrease: $ 35250.82 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ ® Scope of Work <br />.. El Differing Site Conditions, Changed Conditions <br />Current Percent of Change. 7' 9 % ❑ Conflicted Specifications and Drawings <br />. .......--New ❑Failed Materials <br />525250.82 <br />Total Amou t' $�, ❑ Error <br />....... ........ <br />El Omission <br />Total Percent of Change: 7 � 9 % ❑ Final Quantity Adjustment <br />Funding Secured From; �ALCM B.Qrx] <br />(filled out by PM) <br />RECOMMENDED BY: <br />A <br />`TrCd N\11JC ,� 6 .2(.I� <br />Project Inspector (Print Name) (r mature) (Date) <br />REVIEWED BY: <br />y <br />_ ze+—_ . <br />19 <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Engineering Project M m„ ger (Print Name) (S� ature) (Date) <br />APPROVED B <br />1 VI— <br />'Ct r� ry'inear rar t (Sigr a a (Da )m <br />