Amendment No 2 - WWTP Electrical Improvements Proj No. 117-132 - Black and Veatch, Inc.

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City of South Bend Department of Administration & Finance Change Order Request Form Multiple PO lines: PO Number PO-0000128 Line Number Line 1, increase by $6,895.00 or Add Line 2, Amendment No. 2 for amount of $6,895.00 Original Dollar Amount $116,524 (Total Contract before Amend No. 2 = $658,704.00) New Dollar Amount (For liquidation request, enter $0)$123,419 (New Contract after Amend No. 2 = $665,599.00) Reason Code (if changed) Financial Dimensions (fund-dept- division-subdivision-main account)641-06-605-514-431002 Project Code (if applicable)PROJ00000095 Description of change (include budget impact) 117-132 WWTP Electrical Improvements (Consultant / Engineering Services) Amendment No. 2 is an increase in the contact amount of $6,895.00 for additional engineering services and efforts related to changes in the scope of work and adjustments to the final record drawings related to work change directives and value engineering decisions. 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) 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. PO CHANGE FORM for PO-0000128 1 of 5