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Contract No:R -39513 <br />Change Order No.: 002 <br />INDIANA Department of Transportation Page: 2 <br />Construction Change Order and Time Extension Summary <br />Review and Approved Information <br />Required Approval Authority AE: DOE: SCE.,-* DDCM: " <br />($ per Change Order) <br />(Days per Contract) <br />Verbal Approval Required? <br />Total Change To-Date>5°/a? <br />Scope/Design Recommendation <br />Required? <br />(-LE$250K3{-LE$750K-) (--LE$2M--)(--GT$2 M--) <br />( 50 SS days) (100 SS days ) ( 200 SS Days ) ( GT 200 SS days) <br />a/ N If Y, by �_ Date Issued l <br />Y /&f Y, Copy to Program Budget Manager <br />Y / N If Y, Referred to Project Manager(PM) <br />Date to PM <br />Approval Authority Concurs with PM? Y / N if Y, Concurrence by, <br />Date Returned <br />Date <br />If N,Resolution: Approved Disapproved <br />Resolved by Date <br />LPA Signatures Required? N If Y, Date to LPA Date Returned <br />FHWA Signatures Required? Y Gif Y, Date to FHWA,,- ^, , pate Returned <br />* Field Engineer Recommendation (Required for SCE or DDCM Approval) <br />Field Engineer <br />Comments: <br />Date <br />