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Contract No:R -37497 INDIANA Date:07/14/2021 <br />Change Order No:012 Department of Transportation Page: 5 <br />**************************************************************************************************************************** <br />APPROVED FOR LOCAL PUBLIC AGENCY <br />______________________________________________________________________________ <br />(SIGNATURE)(TITLE)(DATE) <br />______________________________________________________________________________ <br />(SIGNATURE)(TITLE)(DATE) <br />**************************************************************************************************************************** <br />SUBMITTED FOR CONSIDERATION <br />PE/S _________________________ <br />**************************************************************************************************************************** <br />APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION <br />Approval Level Name of Approver Date Status <br />Project Engineer/Supervisor Dietz, Don 00/00/0000 Action Pending <br />September 14, 2021