Amendment No. 1 to PSA - Services for Survey and Preparation of Plans for Ignition Park – Jones Petrie Rafinski Corporation

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City of South Bend Department of Administration & Finance Change Order Request Form Multiple PO lines: Project POs: PO Number PO-0003358 Line Number 0 Original Dollar Amount $31,250.00 New Dollar Amount (For liquidation request, enter $0)$37,450.00 Reason Code (if changed)not changed Financial Dimensions (fund-dept- division-subdivision-main account)324-10-102-121-431002--PROJ00000208 (TIF River West Development) Project Code (if applicable)PROJ00000208 Description of change (include budget impact) Addition of $6,200 (20%) to engineering services to include survey and plan preparation for replat at Ignition Park EV Charging Lot site. APPROVED BY PROJECT ACCOUNTING TEAM (if applicable)Amanda Pietsch 2/11/21 PO Number Line Number Original Dollar Amount New Dollar Amount (For liquidation request, enter $0) Reason Code (if changed) Financial Dimensions (fund-dept- division-subdivision-main account) Project Code (if applicable) Description of change (include budget impact) APPROVED BY PROJECT ACCOUNTING TEAM (if applicable)(PAT member's name and date to be completed by PAT member) PO Number Line Number Original Dollar Amount Changing the line amount: You can only change a line amount if it has NOT been invoiced against. •If the line has NOT been invoiced – reduce the line amount to equal what it should be. •If the line has been invoiced – cancel the delivery remainder and finalize the individual line, then add a new line for the amount that should be remaining. If you have changes to more than one line on the same PO, fill out a separate section for each line affected by the change order. For change orders on project-related POs, this form must be approved by the Project Accounting Team as described in Supplement 508. Amendment 1 - Change Order Request Form (4)1 of 3