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Project Number: 118-074D <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Three Twenty at the Cascade - Site Utilities (Div. A & C) 3 <br />Project Name: Change Order #: — <br />DATE INITIATED: 6-15-20 BPW DATE: 7-14-20 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Soil was uncovered that was suspected to be contaminated. Testing was completed and came <br />back negative. An additional catch basin was added to alleviate a noxious smell from a drywell <br />area. <br />Attachments: (List documents support change — required) <br />Soil Testing: Add $313.50 <br />Add Catch Basin: Add $2,100.00 <br />Remove and Replace Rubble: Add $2,857.00 <br />Final Quantity Adjustment: Add $769.00 <br />Amount of DIncrease/ ❑Decrease: $ 6,039.50 <br />Previously approved Change Order(s): $ 20,71 1.00 <br />Current Percent of Change: 3.19 <br />New Total Amount: $ 195,222.50 <br />Total Percent of Change: 15.88 <br />Funding Secured From: 429-10-102-121-442001 <br />(filled out by PM) <br />RECOMMENDED BY: <br />Dan Jones <br />Project Inspector (Print Name) <br />REVIEWED BY: <br />Toy Villa <br />Construction Manager (Print Name) <br />APPROVED BY: <br />Zach Hurst <br />Engineering Project Manager (Print Name) <br />APPROVED BY: <br />Kara Boyles <br />City Engineer (Print Name) <br />Categories (Pick One): <br />❑ Scope of Work <br />0 Differing Site Conditions, Changed Conditions <br />❑ Conflicted Specifications and Drawings <br />❑ Failed Materials <br />❑ Error <br />❑ Omission <br />0 Final Quantity Adjustment <br />El <br />Daniel Jones <br />Dlgilally signed by Daniel Jones <br />DN'. jDaniel Jones.. o=City of 5oulM1 Bend, IN Engineering, <br />wPro�ecl Inspector. email�fones�gsoulbbendin_gw, .-US <br />Dale 2g 0.g4 g615.15:29-04'gg' <br />6-22-20 <br />(Signature) <br />(Date) <br />Toy Villa <br />Digitally signed by Toy Villa <br />6�22�2020 <br />Date: 2020.06.22 20:14:58-04'00' <br />(Signature) <br />(Date) <br />Zachary Hurst <br />91alNsindby drz b, �E bb.d,NB�lale <br />,ery1,,r=' o,BaurbBnnd o <br />DD 21nenl of Publlo Works. ertiaikzM1urst[}sou0rbandhi.gov. WSJ <br />e - aa-0a'o9 <br />6/24/2020 <br />(Signature) <br />(Date) <br />Kara Boyles <br />Digitally signed by Kara Bayles <br />7�21 �2020 <br />Date: 2020.07.21 12:31:00-04'00' <br />(Signature) <br />(Date) <br />