Laserfiche WebLink
CHANGE ORDER REQUEST FORM <br />CONTRACT NO. R-39514-A <br />i <br />i <br />UPON WRITTEN REQUEST FROM THE ENGINEER,VI ADDITIONAL DETAIL <br />f <br />DATE RECEIVED REQUEST FOR August 15, 2019 SUBMITTAL DATE OF August 16, 2019 <br />ADDITIONAL DETAIL ADDITIONAL DETAIL <br />DETAILED DESCRIPTION / JUSTIFICATION: <br />(Include location(s), actions of contractor, owner, and other stakeholders, key events and related cause(s), discoveries, <br />discussions, meetings, and effect on the contract if no action is taken. Also include references to key documents attached <br />or available to support this change order request.) <br />Refer to attached letter and meeting agenda notes <br />PROPOSED SOLUTION — ADDITIONAL DETAILS: <br />(Include proposed scope of work, means & methods, materials, equipment, utility relocation required, subcontracted <br />scope and the effect on the contract schedule. Also include references to attached documents including, but not limited <br />to, sketches, calculations, photos, material information, and submittals and meeting minutes.) <br />Refer to attached letter <br />SIGNATURES <br />Contractor: <br />Name: (print) Ruben Alvarado <br />k ✓�.��a <br />(signature) _ _ Date: 8/15/19 <br />Project Engineer/ upervisor: (signature is to acknowledge receipt of the document and does not signify agreement of the change order) <br />Name: (print) ' _......... m <br />(signature)�� <br />.are± Date: <br />NOTE: The Contractor and PE/S should retain a signed copy of this documentfor record. <br />