Laserfiche WebLink
DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />229.135PmjwfXUQJnqspwfnfout 3 <br />Project Number: _______________ Project Name: __________________________ Change Order #: ____ <br />5.3:.316.23.3131 <br />DATE INITIATED:BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />.Fyjtujoheppsmjoufmjtoputfuvqupbddpnnpebufuifqmboofepwfsifbeepps/Bmbshfseppsxbt <br />offefeupcfvtfe/Bee%24-612/11 <br />.Sfnbjojohtbmucmpdlefnp(egspnuifcsjofuboluptqffevquifdpousbdupstujnfmjof/ <br />Bee%4-:93/11 <br />.Uvcjohtqfdjtpwfsljmm/Dpousbdupsupdsfejucbdlxibujtopuoffefe/Efevdu%4-111/11 <br />Attachments: (List documents support changerequired) <br />Opof <br />25-594/11 <br />o <br />Amount of Increase / Decrease: $____________________ <br />Categories (Pick One): <br />.529-472/11 <br />o <br />Scope of Work <br />Previously approved Change Order(s): $___________________ <br />o <br />Differing Site Conditions, Changed Conditions <br />2/16 <br />Current Percent of Change: ____________________ % <br />Conflicted Specifications and Drawings <br />Failed Materials <br />2-4:3-6:3/11 <br />New Total Amount: $____________________ <br />Error <br />Omission <br />.33/59 <br />Total Percent of Change: ____________________ % <br />Final Quantity Adjustment <br />_______________________ <br />Funding Secured From: __________________________ <br />(filled out by PM) <br />RECOMMENDEDBY: <br />EboKpoft5.27.31 <br />Project Inspector (Print Name)(Signature)(Date) <br />REVIEWED BY: <br />UpzWjmmb502803131 <br />Construction Manager (Print Name)(Signature)(Date) <br />APPROVED BY: <br />LbsbCpzmft602303131 <br />Engineering Project Manager (Print Name)(Signature)(Date) <br />APPROVED BY: <br />LbsbCpzmft602303131 <br />City Engineer (Print Name)(Signature)(Date) <br /> <br />