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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />fH0 <br />Project Number: 119-019A Project Name: 2019 Small Drainage - Lathrop Change Order #: 1 <br />DATE INITIATED 7/9/2019 BPW DATE: _. <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Located manhole structure and lid 6 feet below the surface. Found the pipe to be busted and <br />Installed a new manhole. <br />Attachments: (List documents support change — required) <br />Contractors pricing. <br />Amount of BIncrease / ❑Decrease: $ 1 1 ,840.40 <br />......................................... _.... _...... _ Categories (Pick One): <br />Previously approved Change Order(s): $ 0 ❑ Scope of Work <br />��_-— B Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 47'81 % ❑ Conflicted Specifications and Drawings <br />36,605.40 El Failed Materials <br />New Total Amount $�,�, ❑ Error <br />47.81 El Omission <br />Total Percent of Change: ............. % ❑ Final Quantity Adjustment <br />--� _. 2- 0 <br />Funding Secured From: � �.�""�.�_. <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer .�� m 7/9/2019 <br />Project Inspector (Print Name) (Sigriatur (Date) <br />REVIEWED BY: <br />____ ....... ......... ......... <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY <br />, : <br />City Engineer (Print Na o) (Signature) (Date) <br />