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DEPARTMENT OF PUBLIC WORKS <br />" DIVISION OF ENGINEERING <br />Project Number: 118-076 Project Name: Western Ave Streetscpape Phase 3 Change Order #: <br />DATE INITIATED: 8/29/2019 BPW DATE:. <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution Differing Instructions, Out of Scope, Etc.). <br />Additional work that was done to get around a fiber optic bank that had a different elevation than <br />expected. Changes were also made to the M.O.T. and to the size of some of the catch basins. <br />Additional work was needed for unexpected site conditions that include finding gray marl below the <br />unsuitable peat and the repair of the sanitary lateral for 3401 Western Ave. <br />Attachments: (List documents support change — required) <br />N/A <br />......- _.._.._.._...— ....... <br />_ <br />Amount of Blncrease / ❑Decrease: $41 ,431.00 <br />Categories (Pick One): <br />y pp g ) 0.00 El Scope of Work <br />Previous) approved Change Order(s : $_ ................ <br />8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change: i)on.. % ❑ Conflicted Specifications and Drawings <br />_______________ ....m ..... <br />_ ...... <br />❑ Failed Materials <br />New Total Amount: $2,675,816.35 <br />❑ Error <br />1.57 ❑Omission <br />Total Percent of Change: % ❑ Final Quantity Adjustment <br />Funding Secured From:, 1n <br />(filled out by PM) <br />RECOMMENDED BY: <br />Christopher Nesper <br />4 <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />Toy Villa <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Kyle Silveus <br />Engineering Project Manager (Print Name) (Signa e) (Date) <br />APPROVED BY: <br />Kara Boyles <br />e <br />City Engineer (Print Name) (Signature) I Da <br />t <br />