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05M"C)Y Np;t <br />w A <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />aaens <br />Project Number: 117-055A Project Name: Uncolnway East Corridor Improvements Change Order #: 2 <br />DATE INITIATED. 5/28/2019 <br />BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Damaged Guardrail Repairs, No Police Report or Insurance. <br />Attachments: (List documents support change — required) <br />Invoices from sub -contractors. <br />Amount of B Increase / El Decrease. $ 7,043 89 <br />._.... <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 16, 385.00 <br />❑ Scope of Work <br />_. <br />Current Percent Change: 148 <br />❑ Differing Site Conditions, Changed Conditions <br />of <br />❑ Conflicted Specifications and Drawings <br />......4.8.2.'.428...........�....�........�.` <br />New Total Amount: 89 <br />❑ Failed Materials <br />❑ Error <br />. _........................ W <br />5.10 <br />El Omission <br />Total Percent of Change: <br />❑ Final Quantity Adjustment <br />Funding Secured From <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer <br />6/24/2019 <br />Project Inspector (Print Name) <br />(S'ignatu <br />(Date) <br />REVIEWED BY: <br />I CIA <br />Construction Manager (Print Name) <br />(Signature) <br />(Date) <br />APPROVED BY: <br />Enginee, mg F,oiect Manager (Print Name) <br />(Signa e) <br />(Date) <br />APPROVED BY: <br />Citysneer En 9 ( Print Name) <br />(Sigraatura I <br />(Date) <br />