My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
Change Order Nos 2-3 - Coal Line Trail, Phase IIA Proj No. 115-063 - INDOT Selge
sbend
>
Public
>
Public Works
>
Board of Works Documents
>
2024
>
Change Orders
>
Change Order Nos 2-3 - Coal Line Trail, Phase IIA Proj No. 115-063 - INDOT Selge
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
4/23/2024 3:00:28 PM
Creation date
4/23/2024 3:00:23 PM
Metadata
Fields
Template:
Board of Public Works
Document Type
Projects
Document Date
4/23/2024
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
13
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
Show annotations
View images
View plain text
Contract No:R -38065 Change Order No.: 002 <br />INDIANA Department of Transportation Page: 2 <br />Construction Change Order and Time Extension Summary <br />Review and Approval Information <br />Required Approval Authority AE:________ DCE:________ SCE:________* DDCM:_______* <br />($ per Change Order) (- LE $ 250K-) (- LE $ 750K - ) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- ) <br />(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days) <br />Verbal Approval Required? Y / N If Y, by_____________ Date Issued___________ <br />Total Change To-Date>5%? Y / N If Y , Copy to Program Budget Manager_________________ <br />Scope/Design Recommendation <br />Required? <br />Y / N If Y, Referred to Project Manager(PM) __________________ <br />Date to PM__________ Date Returned___________ <br />Approval Authority Concurs with PM? Y / N If Y, Concurrence by_______________ Date___________ <br />If N,Resolution: Approved __________ Disapproved ___________ <br />Resolved by_________________________ Date__________ <br />LPA Signatures Required? Y / N If Y, Date to LPA _____________ Date Returned _________ <br />FHWA Signatures Required? Y / N If Y, Date to FHWA____________ Date Returned_________ <br />* Field Engineer Recommendation (Required for SCE or DDCM Approval) <br />Field Engineer _________________________ Date _____________ <br />Comments: ____________________________________________________________ <br />______________________________________________________________________ <br />______________________________________________________________________ <br />______________________________________________________________________ <br />______________________________________________________________________
The URL can be used to link to this page
Your browser does not support the video tag.