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1965 <br />Project Number: 116-082D <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Name: Miami Basin Valve Replacement Change Order #: 1 <br />DATE INITIATED: 10/1/2020 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Adjustment to final quantities. <br />Attachments: (List documents support change — required) <br />Amount of El Increase / ODecrease: $ 740.52 <br />Previously approved Change Order(s): $ 0 <br />Current Percent of Change: '42 <br />New Total Amount: $ 175,259.48 <br />Total Percent of Change: '42 <br />Funding Secured From: <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer <br />Project Inspector (Print Name) <br />REVIEWED BY: <br />Toy Villa <br />Construction Manager (Print Name) <br />APPROVED BY: <br />Jacob M. Klosinski <br />Engineering Project Manager (Print Name) <br />APPROVED BY: <br />Categories (Pick One): <br />❑ Scope of Work <br />❑ Differing Site Conditions, Changed Conditions <br />❑ Conflicted Specifications and Drawings <br />❑ Failed Materials <br />❑ Error <br />❑ Omission <br />*1 Final Quantity Adjustment <br />13 <br />AL 10/1 /2020 <br />(Signature) (Date) <br />7� Vd& 10/15/2020 <br />(Signature) (Date) <br />(Signature) <br />10/15/20201 <br />(care/ <br />City Engineer (Print Name) <br />(Signature) <br />(uare) <br />