HomeMy WebLinkAboutAmendment No 1 to OEA - As Needed, On Call Support to Implement Impervious – Christopher B. Burke Engineering, LLC - TABLEDDecember 14, 2021
City of South Bend
Department of Administration & Finance
Change Order Request Form
Multiple PO lines:
Project POs:
PO Number PO-000355
Line Number 2
Original Dollar Amount $0.00
New Dollar Amount
(For liquidation request, enter $0)$23,010.76
Reason Code (if changed)
Financial Dimensions (fund-dept-
division-subdivision-main account)667-06-605-517-442002
Project Code (if applicable)NA
Description of change (include
budget impact)
Amendment to provide as needed, on-call support to implement the impervious cover-
based stormwater utility.
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)Ron O'Connor 12/07/2021
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)
Description of change (include
budget impact)
APPROVED BY PROJECT
ACCOUNTING TEAM (if applicable)(PAT member's name and date to be completed by PAT member)
PO Number
Line Number
Original Dollar Amount
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 one line on the same PO, fill out a separate section for each line affected by the change
order.
For change orders on project-related POs, this form must be approved by the Project Accounting Team as described in
Supplement 508.
2021 12 December 7 PO-000355Christopher Burke Amendment for 23010.76 - Sue Ellen (1)1 of 3