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Contract No:R -39540 <br />1ND寡ÅNA Department of T略nSPO鴫ation <br />Const叩ctlon Change Orde「 and Tlme Extension Summary <br />Review and Approva=nfo「mation <br />Required Approval Authority <br />($ per Change Order〉 <br />(Days per Contract) <br />Verbal App「ova旧equired? <br />Total Change To-Date>5%? <br />ScopeIDesign Recommendation <br />Required? <br />Change Order No.: 002 <br />Page: 2 <br />AE:　　　　DCE:　　　　SCE:　　　　* DDCM:　　　★ <br />(-LE$250K一〉(-LE$750K-〉(○○LE$2M-輸)(--GT$2M--) <br />(50SSdays) ( 100SSdays) (200SSDays) (GT200SSdays) <br />Y/NlfY,by Date Issued <br />Y / N lfY , Copyto Program Budget Managl <br />Y / N lf Y, Beferred to Pr句ect Manager(PM) <br />Date to PM <br />Approval Authority Concurs with PM? Y / N lf Y, ConclIrrenCe by <br />lf N,ResoIution: Approved <br />ResoIved by <br />Date Returned <br />D i s approved <br />Date <br />しPA Signatu「es Required?　　　　　Y I N If Y, Date to LPA <br />FHWA Signatu「es Required?　　　　Y / N lf Y, Date toFHWA <br />’Fieid Engineer Recommendation (Required for SCE or DDCM ApprovaI) <br />Field Engineer <br />Comments: <br />Date <br />Date Returned <br />Date Retumed