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Contract No:R -35727 Change Order No.: 005 <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 -- <br />) ( <br />Y <br />(Days per Contract) ( 50 SS days ) ( 100 SS days ) ( 200 SS Days ) )( GT 200 SS <br />Verbal Approval Required? <br />Y / N If Y, by Date Issued <br />Total Change To-Date>5%? <br />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? <br />Y / N If Y, Concurrence by Date <br />If N, Resolution: Approved Disapproved <br />Resolved by Date <br />LPA Signatures Required? <br />Y / N If Y, Date to LPA Date Returned <br />FHWA Signatures Required? <br />Y / N If Y, Date to FHWA Date Returned <br />* Field Engineer Recommendation (Required for SCE or DDCM Approval) <br />Field Engineer <br />Date <br />Comments: <br />