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w�e rar &A, <br />DEPARTMENT OF PUBLIC WORKS <br />*" DIVISION OF ENGINEERING <br />kdipti <br />Project Number: 118-043R <br />Project Name: PA Restroom Remodeiing Change Order #: 2 <br />DATE INITIATED: 8/12/19• <br />BPW DATE: 9/10/19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Time extension request due to unforeseen conditions. <br />Attachments: (List documents support change — required) <br />Formal request from contractor. <br />PCR#002. <br />Amount of ❑ Increase / ❑ Decrease:; <br />�1 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ Mt.t ❑ Scope of Work <br />--............. <br />-. 8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change; <br />. . . . . . — % ❑ Conflicted Specifications and Drawings <br />El Failed Materials <br />New Total Amount: $ <br />❑ Error <br />.wwwww <br />❑ Omission <br />Total Percent of Change: _�� <br />% ❑ Final Quantity Adjustment <br />Funding Secured From: Axrle.s Zpy&Z <br />(filled out by PM) <br />RECOMMENDED BY: <br />Greg McGowan <br />Project Inspector (Print Name) <br />(Signature) <br />(Date) <br />REVIEWED BY: <br />n' <br />9 <br />Construction Manager (Print Name) <br />(Signature) <br />(Date) <br />APPROVED BY: <br />r r eeL"v-) <br />r <br />Q q-19 <br />Project anager (Print Name) <br />(Signature) <br />(Date) <br />APPROVED BY: <br />u <br />City Engineer (Print' Name,y <br />g <br />(Smgnatd e) <br />(Deice) d d <br />