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CITY OF SOUTH BEND, INDIANA ' <br />DEPARTMENT OF PUBLIC WORKS <br />PROJECT CHANGE ORDER <br />DATE: 10/18/2019 <br />PROJECT NO: 119-004 <br />PROJECT NAME: 2019 Curb & Sidewalk Div.D2 <br />CONTRACT DATE: 5/28/2019 <br />CHANGE ORDER NO: 1 Final <br />SUBJECT OF CHANGE ORDER: PCR #1-Adjustment to Final Quantities and Damages. <br />All items completed substantially as planned. <br />See attached Comparison of Estimate for overruns and underruns.. <br />The original contract sum <br />Net change by previously authorized change orders <br />The contract sum prior to this change order <br />By this Change Order, the project amount is <br />The new contract sum including this change order <br />This Change Order represents a total change of <br />Total change for entire project <br />Original contracted completion date/time <br />Extension of date/time by previous change orders <br />Date/time extension by this change order <br />New completion date/time <br />CONTRACTOR <br />6;ac gnature <br />,Pa <br />Printed Name and Title <br />Premium Concrete Services, Inc. <br />Company Name <br />712 Richmond <br />Address <br />Elkhart, IN 46516 <br />City, State, Zip <br />Increased <br />FXDecreased <br />11/15/2019 <br />0 days <br />0 days <br />11/15/2019 <br />42,124.00 <br />0.00 <br />42.124.00 <br />$ 3,015.10 <br />$ 39,108.90 <br />-7.16 % <br />-7.16 % <br />. :o. r r • , <br />I�iMmwliliou��ul <br />Eiar*PON <br />CITY OF SOUTH BEND <br />BOARD OF PUBLIC, WORKS <br />Approved Date; l' <br />z <br />Ga A. Gilot "'President <br />9 <br />Genevieve EWaradik, <br />ember <br />Elizabeth A.Member <br />TherJ. Dorau, Memb r? <br />I J ( <br />Laura O'SulllivaCi, M tuber - <br />