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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 119-059 Project Name: Fire Station Parking Lot Improvements Change Order #: 1 <br />FDATE INITIATED: 10-18-19 BPW DATE: 11-26-19 <br />Brief Summary of Change Order; (Construction Change Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Remove work from the Central FS and add more full depth patching, mill/surface, and bollard <br />replacement at FS #11 <br />Attachments: (List documents support change — required) <br />See attached price breakdown <br />Amountof Blncrease/ ❑Decrease: $4,861.01 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0' 00 8 Scope of Work <br />El Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 3 93 <br />❑ Conflicted Specifications and Drawings <br />....._.............. 128,678.5.1.................................�......................._ ❑Failed Materials <br />New Total Amount: $„ ❑ Error <br />........ <br />8 Omission <br />Total Percent of Change: 3.93 <br />❑ Final Quantity Adjustment <br />Funding Secured From, - <br />(filled out by PM)� � <br />Z'- µ <br />RECOMMENDED BY: <br />Dan Jones - <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />To Villa <br />Y ............ 1 9 14 <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Charlotte Brach / .,...... t -t <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Kara Boyles <br />City Engineer (Print Name) 4inat ) (Date) <br />