Change Order No 2 - River Walk from Beyer St. to Notre Dame Boathouse Proj No. 117-083 - Walsh & Kelly, Inc.

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City of South Bend Department of Administration & Finance Change Order Request Form 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. Multiple PO lines: If you have changes to more than two lines on the same PO, fill out a separate section for each line affected by the change order. Project POs: For change orders on project -related POs, this form must be approved by the Project Accounting Team as described in Supplement 508. PO Number 6604 Line Number 4 Original Dollar Amount $25,880.22 New Dollar Amount For liquidation request, enter $0 $32,947.07 Reason Code if changed) Financial Dimensions (fund-dept- division -subdivision -main account 471-11-206-282-444000 Project Code if applicable) Proj-0072 Description of change (include bud et impact) Change order #2 for the additional bank stabilization and temporary fencing along the project limits. APPROVED BY PROJECT ACCOUNTING TEAM (if applicable) Ron O'Connor 2-5-2021 PO Number 6604 Line Number 5 Original Dollar Amount $0.00 New Dollar Amount For liquidation request, enter $0 $34,525.00 Reason Code if changed) SV Financial Dimensions (fund-dept- division -subdivision -main account 251-06-600-506-442001 Project Code if applicable) Proj-0072 Description of change (include budget impact) Change order #2 for the additional bank stabilization and temporary fencing along the project limits. APPROVED BY PROJECT ACCOUNTING TEAM (if applicable) Ron O'Connor 2-5-2021 PO Number Line Number Original Dollar Amount 2021 02 February 5 PO 6604 Walsh Kelly VPA Change Order Request Form 1 of 3