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SOUTH BEND PARKS PROGRAM <br />CHANGE ORDER NO. -12- COVER SHEET <br />DATE INITIATED: 12-13-19 REQUIRED APPROVAL DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />1.Partial Cafe Buildout w/HVAC & SOG for finishing by Others <br />A. Larson Danielson will need to be contacted to have Dudeck Roofing & Sheet Metal do all roof penetrations over the CaW This change order <br />pays for future build out of the roof. This will preserve the warranty <br />Increase/(Decrease) from previously approved Change Order(s): <br />$, 22g Q22.58 <br />Date/Time Added: <br />New Contract Sum with This Change Order: <br />$ _ 18 833 F58.15 <br />Percent of Change Order: <br />SUBMITTED/PREPARED BY: <br />rdN i'D G0h Vq <br />Resident Project Representative (Print me) <br />RECOMMENDED: <br />Construction Mana r (Print Name) <br />RECOMMENDED: <br />Project Manager (Print Name) <br />REVIEWED: <br />Project Manager, Venue, Parks and Arts (Print Name) <br />RECO MENDED FOR APPROVAL: <br />w <br />Director, Venue, Parks and Arts (Print Name) <br />(HICK Une): <br />0 Scope of Work <br />El Differing Site Conditions, Changed Conditions <br />0I Conflicted Specifications and Drawings <br />Failed Materials <br />Errors and Omissions <br />Incentive/Disincentive <br />Final Quantity Adjustment <br />Owner Directed <br />ENDORSEMENTS/APPROVALS <br />(Date) <br />a 101 <br />(Date) <br />/�/ 7 <br />(Date) <br />/Z. /-?./fr <br />(Date) <br />........... <br />(Date) <br />