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�.� DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 118-056 Project Name: Pulaski Park Improvements Change Order#: 1 <br />DATE INITIATED: 10/03/2019 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />9 week time extension requested due to lead time for restroom facility design and materials. New <br />completion date- 12/20/2019 <br />Attachments: (List documents support change — required) <br />Change request from contractor. <br />Amount of ❑ Increase / ❑ Decrease: $ NSA <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0 ❑ Scope of Work <br />-- ------ ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 0 % ❑ Conflicted Specifications and Drawings <br />. <br />New Total Amount: -$ 878, 6.86.25 <br />❑ Failed Materials <br />❑ Error <br />... . .. .. I] Omission <br />Total Percent of Change: % ❑ Final Quantity Adjustment <br />Funding Secured From: <br />(filled out by PM) <br />RECOMMENDED BY: <br />Greg McGowan io -10�1 q <br />Project Inspector (Print Name) ( gnature) (Date) <br />REVIEWED BY: <br />.. <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />10 1►{ 19 <br />Engineering Project Manager (Print Name) (Sign re) (Date) <br />APPROVED BY: <br />City Engineer (Print Name ,(Signat(rr) <br />