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Contract No:R -43125 INDIANA Date:08/30/2022 <br />Change Order No:003 Department of Transportation Page: 3 <br />Contract:R -43125 <br />Project:1902178 - State:190217800LC4 <br />Change Order Nbr: 003 <br />Change Order Description: Castings provided and adjusted to grade <br />Reason Code:CHANGED COND, Materials Related <br />CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change <br />0082 1902178 0082 720-01894 EACH 1,033.530 5.000 C Amount:$ 5,167.65 <br />Item Description:CASTING FURNISH AND ADJUST TO GRADE <br />Supplemental Description1: 7.0 inch tall fram, solid cover (1 w/gasket sanitary sewer) <br />Supplemental Description2: <br />Total Value for Change Order 003 = $ 5,167.65 <br />Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended. <br />General or Standard Change Order Explanation <br />5/7 castings to be adjusted on project were found to be damaged beyond further use. <br />Change Order Explanation for Specific Line Item <br />**************************************************************************************************************************** <br />It is the intent of the parties that this change order is full and complete compensation for the work describe above. <br />Notification and consent to this change order is hereby acknowledged. <br />Contractor:____________________________________________Signed By:_____________________________________________ <br />Date:__________________________________________________ <br />*************************************************************************************************************************** <br />NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system.