Amendment No. 4 to OEA - Design Srvs. for Seitz Park Phase II Proj No. 117-093B

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City of South Bend Department of Administration & Finance Change Order Request Form Multiple PO lines: Project POs: PO Number PO-0001787 Line Number 10 Original Dollar Amount $0.00 New Dollar Amount (For liquidation request, enter $0)$36,360 Reason Code (if changed) Financial Dimensions (fund-dept- division-subdivision-main account)201-11-206-273-444000 Project Code (if applicable)Proj-0079 Sietz Park Description of change (include budget impact) Amendment number 4 covers additional design effort, preparation of constriction documents, and construction administration services for the Seitz Park Reconstruction Phase II project which includes the Riverwalk from Howard Park to Seitz Park on the east bank of the river. APPROVED BY PROJECT ACCOUNTING TEAM (if applicable)Ron O'Connor 07/19/2021 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) PO Number Line Number 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 two lines 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. 2021 07 July 15 PO-1787 Smithgroup - Amendment 4 -- 36,360.xlsx 1 of 3