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Premium Concrete <br />Company Name <br />712 Richmond St <br />Address <br />Elkhart, IN 46516 <br />City, State, Zip <br />CITY OF SOUTH BEND, INDIANA <br />DEPARTMENT OF PUBLIC WORKS <br />PROJECT CHANGE ORDER <br />DATE: <br />PROJECT NO: <br />PROJECT NAME: <br />CONTRACT DATE: <br />CHANGE ORDER NO: <br />SUBJECT OF CHANGE ORDER: <br />The <br />VVI Ili 0I t pUlll <br />css <br />10/1 V2016 0:00:00 <br />116-029 - Div B <br />2016 Curb and Sidewalk Construction <br />4/2612016 <br />PCR #1-Remove Curb Islands on Mishawaka Ave from contract <br />Net change by previously authorized change orders <br />The contract sum prior to this change order <br />By this Change Order, the project amount is <br />The new contract sum including this change order <br />This Change Order represents a total change of <br />Total change for entire project <br />Extension of date/time by previous change orders <br />Date/time extension by this change order <br />New completion date/time <br />CONTRACTOR <br />c <br />o act r ignature <br />Printed Name and Title BOARD OF PUBLIC WORKS <br />Approved Date: 2p/(0 <br />n� .Z <br />Gary A. Gilot, President <br />$ <br />25,575.00 <br />$ <br />0.00 <br />$ <br />Increased <br />25,575.00 <br />QXDecreased $ <br />19,065.00 <br />$ <br />6,510.00 <br />-74.55 <br />-74.55 <br />% <br />10/13/2016 0:00:00 <br />0 days <br />10/13/2016 <br />RECOMMENDED FOR APPROVAL <br />1 <br />CONST !d TION MANAGER <br />CITY OF SOUTH BEND <br />