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xw DEPARTMENT OF PUBLIC WORKS <br />` DIVISION OF ENGINEERING <br />amn,� <br />11 8-035A �r Iwy Gernter Parking &pit Entry �Gaaleway trtnpriwarna 1 <br />Project Number: Project Name: anlChange Order #: <br />DATE INITIATED, 11/07/19 BPW DATE: 11/26/19 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Winter heated concrete, winter blankets, and fast cure concrete added for a cold weather concrete <br />pour. <br />Attachments: (List documents support change — required) <br />Larson Danielson Change Request <br />Amount of Blncrease / ❑Decrease: $ 2,775.99 <br />Categories (Pick One): <br />Previously approved Change Order(s): $, 0 ❑ Scope of Work <br />8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change: '$ % ❑ Conflicted Specifications and Drawings <br />El Failed Materials <br />New Total Amount: $ 158,724.43 <br />❑ Error <br />❑ Omission <br />Total Percent of Change: 1 '8 _ % ❑ Final Quantity Adjustment <br />Funding Secured From:., <br />Hotel Motel Tax Fund <br />(filled out by PM) <br />RECOMMENDED BY: <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />1 <br />Construction Mana r (Print Name) (Signature) • (Date) <br />APPROVED BY: <br />bum VILMU <br />1 <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />a n <br />r <br />City Engineer (Print ame) (Sign ; ) (Date) <br />