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CONTRACT NO. 1 13-44292-A <br />! <br />r <br />PROJECT DESCRIPTION <br />(route/ intersection / bridge no(s).) <br />,I° <br />DATE OF SUBMISSION March 28, 2023 <br />Coal Line Trail over the St. Joseph River <br />CHANGE ORDER REQUEST SUMMARY i Change in Pedestrian Railing Details <br />DESCRIPTION <br />PROPOSED SOLUTION SUMMARY Adjusted Pedestrian Railing <br />NOTE: Upon request from Engineer, enter detailed description on page 2. <br />............... <br />ONSET DATE OF CHANGE November 1, 2022 ! CHANGE ORDER TYPE <br />104.02 Changed Conditions <br />COST COST INCREASE / (DECREASE): $ f 23,283 90 <br />The cost adjustment shall include lump sum and/or estimated totaled unit -priced item costs. Attach a separate she11 et of unit price items <br />including item description, unit of measurement, estimated quantity and unit price. <br />CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF COST CHANGE: <br />❑ 109.03 Altered Quantities ® 109.05(a) Agreed Price ❑ 109.05(b) Force Account ❑ 109.05.02 Delay Costs <br />PROPOSED COST CHANGE INCLUDES: ® Labor IR Material ❑ Equipment ❑ Lease Agreement ❑ <br />Subcontractor <br />IME ADJUSTMENT INCREASE / (DECREASE): (work days) 0 <br />i <br />CHECK APPROPRIATE BOXES PER APPROPRIATE BASIS OF TIME CHANGE: <br />❑ 108.08(a) Excusable, Non-Compensable ❑ 108.08(b) Excusable, Compensable <br />NOTE: If Compensable, attach details based on 109.05.2(a) Allowable Delay Costs. <br />SUPPLEMENTAL INFORMATION <br />Additional information. <br />CHANGE ORDER ORIGINATION: ❑ INDOT / LPA ®Contractor <br />_.. <br />DOCUMENTS AFFECTED: <br />.-- <br />❑ Contract Specifications (ref. doc name/no.) <br />® Contract Plans (ref. doc name/no.) <br />CHANGE ORDER AFFECTS DBE PARTICIPATION: <br />CIiC�C ti@tit ia3 h',lTIEt? fE'X(. <br />Page 35 of 39 <br />❑ yes ® no (if yes, attach details) <br />Ver. '10.18.18 <br />