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�DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 1 18-075 Project Name: Michigan Street Pavement Replacement <br />Change Order #: 1 <br />DATE INITIATED: 9/18/19 ry ry <br />BPW DATE; <br />Brief Summary of Change Order; (Construction Change Alternative, Substitution, Differing Instructions, Out of Scope, Etc.), <br />-Stop Sign Flashing Beacons <br />-Replace Storm Structure #6071 <br />-Wayfinding Pole Foundations <br />-XyPex Waterproofing <br />-Contract Days for Additional Work. <br />Attachments: (List documents support change — required) <br />Contractor Pricing. <br />Amount of Blncrease / El Decrease: $ 25,195.60 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0 <br />8 Scope of Work <br />— -- <br />1.32 <br />8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change: <br />❑ Conflicted Specifications <br />and Drawings <br />New Total Amount: $ <br />❑ Failed Materials <br />❑ Error <br />__................................................... <br />1.32 <br />❑ Omission <br />Total Percent of Change: <br />❑ Final Quantity Adjustment <br />Funding Secured From <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer <br />- <br />9/19/19 <br />Project Inspector (Print Name) (Signadc <br />(Date) <br />REVIEWED BY: <br />_... d� \►� <br />9. 63•I91 <br />Construction Manager (Print Name) (Signature <br />Date <br />APPROVED BY: <br />3 ! <br />Engineering Project Manager (Print Name) , ig t <br />(Date) <br />APF'RQV D BY: <br />City Engineer (Print Name)(Signat± <br />(Dat <br />