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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />118-086 R Liberty Tower Improvements DivB -Mulder 1 <br />Project Number: Project Name: Change Order #: <br />DATE INITIATED: 8/27/19 BPW DATE: �.. <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Fill Exterior Louvers on Building and Fee to use Adjacent Property Owners Lot. <br />Attachments: (List documents support change — required) <br />Contractor Pricing, Bid Proposal, & License Agreement, <br />Amount of BIncrease / ❑ Decrease: $ 1 1 , 715.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $, 0 ® Scope of Work <br />Current Percent of Change: 3'95 . . . . . . . ❑Differing Site Conditions, Changed Conditions <br />❑ Conflicted Specifications and Drawings <br />0 ❑Failed Materials <br />New Total Amount: $ ' ❑ Error <br />❑ Omission <br />Total Percent of Change: 3.95 % ❑ Final Quantity Adjustment <br />Funding Secured From. 324-lcso- 460- y2-o•Z <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer rw 8/27/19 <br />Project Inspector (Print Name) (Sign r') (Date) <br />REVIEWED BY: <br />rnName) (Signature) nature�) (Date)Construction Man g(P <br />APPROVED BY: <br />Engineering Protect Manager (Print Name) (Signat ) (Date) <br />APPROVED BY: <br />(Sig <br />Engineer (Print Name) e) (Date <br />