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DATEAUTHORIZING SIGNATURE: <br />SIGNATURE DATE <br />SIGNATURE DATE <br />SIGNATURE DATE <br />SIGNATURE DATE <br />-$53,575.06$4,089,000.00 <br />Original Over/Under <br />FIELD CHECKED BY:PROJECT ENGINEER/SUPERVISOR CERTIFICATION: <br />I do hereby certify that the final pay quantities shown above are true and correct for the <br />items of work completed on this contract. <br />CENTRAL OFFICE REVIEW:DISTRICT REVIEW OFFICER <br />I have examined the supporting documentation and checked the final quantities shown <br />and recommend payment thereof. <br />Amounts Final <br />$4,035,424.95 -$113,467.07 <br />Original + CO <br />Over/Under <br />$59,892.01 <br />Approved CO <br />Over/Under Quantity = Final Quantity - Original Quantity <br />Original + CO Over/Under Quantity = Final Quantity - Original Quantity - Approved Change Order Quantity <br />Final Quantity = Authorized DWR Item Quantity <br />Having reviewed this document for the above listed contract, I hereby agree that the <br />Final Quantity Amount is acceptable. <br />CONTRACTOR CERTIFICATION: <br />CONTRACTOR'S NAME: <br />Preliminary <br />Final <br />* = Non-Participating <br />CONSTRUCTION RECORD <br />Comparison of Original and Final Quantity Amounts (CLN) <br />INDIANA DEPARTMENT OF TRANSPORTATION12/09/2021Report Date: <br />Page 15 of 15 <br />R -37497Contract ID <br />Original <br />Quantity <br />Amount <br />Over/Under <br />Quantity <br />Amount <br />Final <br />Quantity <br />AmountUnit PriceItem Description <br />Non- <br />Participating <br />Approved <br />CO <br />Quantity <br />AmountCLN <br />Original + CO <br />Over/Under <br />Quantity <br />Amount <br />IC642 REV 02/10