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CITY OF SOUTH BEND, INDIANA <br />DEPARTMENT OF PUBLIC WORKS <br />PROJECT CHANGE ORDER <br />DATE: 9/27/2019 <br />PROJECT NO: 119-071 <br />PROJECT NAME: Walnut Grove and North Riverside Drive Traffic Calmin <br />CONTRACT DATE: 8/22/2019 <br />CHANGE ORDER NO: 1 (Final) <br />SUBJECT OF CHANGE ORDER: PCR #1-Concrete Pavement Removal and Backfill <br />All items completed substantially as planned. <br />See attached Comparison of Estimate for overruns and underruns. <br />The original contract sum <br />Net change by previously authorized change orders <br />The contract sum prior to this change order <br />By this Change Order, the project amount is <br />The new contract sum including this change order <br />This Change Order represents a total change of <br />Total change for entire project <br />Original contracted completion date/time <br />Extension of date/time by previous change orders <br />Date/time extension by this change order <br />New completion date/time <br />CONTRACTOR <br />Contractor Signature <br />M'HY*AKC-,-J V.P. <br />Printed Name and Title <br />Premium Concrete Service, Inc. <br />Company Name <br />712 Richmond Street <br />Address <br />Elkhart, IN 46516 <br />City, State, Zip <br />XI Increased <br />❑ Decreased <br />10/15/2019 <br />0 days <br />0 days <br />10/1512019 <br />77,500.00 <br />0.00 <br />77. 500.00 <br />$ 3,836.00 <br />$ 81, 336.00 <br />4.95 % <br />4.95 % <br />RECOMMENDED FOR APPROVAL <br />%e t1d& <br />CONSTRLXTION MANAGER <br />CITY OF SOUTH BEND <br />BOARD OF PUBLIC WORKS <br />Approved Date: October 27, 2020 <br />Gary A. Gilot, President <br />Elizabeth A. Maradik, Member <br />Joseph R. Molnar, Member <br />Therese J. Doran, Member <br />Jordan V. Gathers, Member <br />ATTEST: <br />-42111l,r C> 6727n <br />Linda M. Martin, Clerk <br />