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City of South Bend <br />Department of Administration & Finance <br />Change Order Request Form <br />Multiple PO lines: <br />PO Number PO-0005026 <br />Line Number 1 <br />Original Dollar Amount $1,684,640.00 <br />New Dollar Amount <br />(For liquidation request, enter $0)$0.00 <br />Reason Code (if changed) <br />Financial Dimensions (fund-dept- <br />division-subdivision-main account)Project category 265-436008 <br />Project Code (if applicable)PROJ00000001 <br />Description of change (include <br />budget impact) <br />Cancel delivery remainder in order to add a second line with the amount that should <br />be remaining. There was an error when this PO was set up and it isn't hitting the <br />project the way it should. <br />PO Number PO-0005026 <br />Line Number 2 <br />Original Dollar Amount $0.00 <br />New Dollar Amount <br />(For liquidation request, enter $0)$862,942.21 <br />Reason Code (if changed)PW-PS <br />Financial Dimensions (fund-dept- <br />division-subdivision-main account)Project category 265-436008 <br />Project Code (if applicable)PROJ00000001 <br />Changing the line amount: <br />You can only change a line amount if it has NOT been invoiced against. <br />• If the line has NOT been invoiced – reduce the line amount to equal what it should be. <br />• If the line has been invoiced – cancel the delivery remainder and finalize the individual line, then add a new line for the <br />amount that should be remaining. <br />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 <br />order. <br />Copy of Change Order - PO-0005026 Correction 1 of 2