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DEPARTMENT OF PUBLIC WORKS <br />kk Cr <br />DIVISION OF ENGINEERING <br />118-024 �w,.���A,����� 1 <br />Project Number: Project Name: Change Order #: <br />DATE INITIATED 10-9-19 BPW DATE: 10-22-19� <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc,). <br />Various value engineering items were incorporated to decrease the overall <br />Attachments: (List documents support change — required) <br />Breakdown of all deduct items attached <br />Amountof ❑Increase/ BDecrease: $418,361.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ �'R Scope of Work <br />❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: -23.29 % ❑ Conflicted Specifications and Drawings <br />New Total Amount:1 � 378109.00 El Failed Materials <br />❑ Error <br />El Omission <br />Total Percent of Change: 3.49 <br />❑ Final Quantity Adjustment <br />Funding Secured From; El <br />(filled out by PM) <br />RECOMMENDED BY: <br />Dan Jones <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />Toy Villa <br />........... <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />&I <br />•IS�I <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Kara Boyles �0•�h• �� <br />tur) City Engineer (Print Name) (Sign(Date) <br />