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yglMk N'Ip M1 <br />h <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />1 1 9-52 R COSB Wayfinding Signage Program - Phase 1 1 <br />Project Number: Project Name: Change Order #» <br />��MMMMM� <br />DATE INITIATED: 11/20/19 BPW DATE: 20 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Add 63 Contract Days Due to Decorative Pole Lead Time. <br />Attachments: (List documents support change — required) <br />Contractors request & time -line. <br />Amount of ❑ Increase / ❑ Decrease: $ <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: % ❑ Conflicted Specifications and Drawings <br />­­­....... . . . ...................... <br />❑ Failed Materials <br />New Total Amount; $ 139,157.00 <br />❑ Error <br />El Omission <br />Total Percent of Change: % ❑ Final Quantity Adjustment <br />Funding Secured From: <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer 11/27/19 <br />Project Inspector (Print Name) (Signet ;) \ (Date) <br />REVIEWED BY: <br />, e e <br />Construction Manager (Print Name) (Signature) (Date) <br />S Loo�- <br />APPRO ED BY: <br />Engineering Project Manager (Print Name) (Signature) (Date <br />APPROVED BY: <br />City Engineer (Print Na e) (Signature) (Date <br />