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sp41N 1`i6 qy,,. <br />DEPARTMENT OF PUBLIC WORKS <br />a DIVISION OF ENGINEERING <br />Project Number: 118-013B Project Name: Privet Lane Culvert Replacement Change Order #: 1 <br />DATE INITIATED: August 13, 2020 BPW DATE: September 8, 2020 <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Deduct for material usage, time extension for delay on gas line relocation in April/May 2020 <br />Attachments: (List documents support change — required) <br />Final Pay Estimate <br />/ <br />.. .___........ ... <br />Amount of ❑Increase/ BDecrease: $ (3,883.22) <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: m� 1 .47) <br />❑ Conflicted Specifications and Drawings <br />New Total Amount:$ 26__................. �.............. <br />0, 587.7$ .......... El Failed Materials <br />- ❑ Error <br />❑ Omission <br />Total Percent of Change: (1.47^) ITITIT <br />8 Final Quantity Adjustment <br />Funding Secured From: LRSA Major Projects 2019 0 <br />(filled out by PM) <br />RECOMMENDED BY: <br />Rebecca Plantz <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />Toy Villa $ . �q , Z., <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Rebecca Plantz <br />pB zo <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Kara Boyles �c Cie 8.21.2020 <br />City Engineer (Print Name) (Signature) (Date) <br />