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'40 <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 118-090 Project Name: ���"�"��`Bawd°w..R.��"`�""�"�"°`�°"�� Change Order#: <br />DATE INITIATED 9-5-19 <br />BPW DATE: 10-22-19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Data ports were added to meet end user requirements. <br />Attachments: (List documents support change — required) <br />N/A <br />Amount of eIncrease / El Decrease: $2,850.00 <br />mmmmITW <br />.............. <br />- <br />_'... <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0.00 <br />8 Scope of Work <br />7.94mm <br />-- ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: -• <br />El Conflicted Specifications and Drawings <br />38,750... .... <br />New Total Amount: $ .00 <br />❑Failed Materials <br />❑ Error <br />7.94 <br />❑ Omission <br />Total Percent of Change: ---••• •••---• <br />❑ Final Quantity Adjustment <br />Funding Secured From: 214 04-It- 415, t) <br />(filled out by PM) -T-r Ptof, , (: <br />RECOMMENDED BY: <br />Dan Jones <br />t <br />� PA - <br />(q <br />Project Inspector (Print Name) <br />Signature)' <br />(Date) <br />REVIEWED BY: <br />Toy Villa <br />CLA <br />to. <br />Construction Manager (Print Name) <br />(Signature) <br />(Date) <br />APPROVED BY: <br />Zach Hurst <br />Engineering Project Manager (Print Name) <br />(Signature) <br />(Date) <br />APPROVED BY: <br />Kara Boyles <br />Q <br />loll <br />City Engineer (Print Name) <br />(Si nat�rr) <br />(Dag <br />