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Contract No:R -39513 Change Order No.: 003 <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) (- LIE $ 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? YOf Y, by Date Issued <br />Total Change To-Datey5%? Y /@N If Y, Copy to Program Budget Manager__ <br />Scope/Design Recommendation Y I( If Y, Referred to Project Manager(PM) <br />Required? <br />Date to PM Date Returned <br />Approval Authority Concurs with PM? 0 N If Y, Concurrence by Date <br />If N,Resolutlon: Approved Disapproved <br />Resolved by Date <br />LPA Signatures Required? 0 N If Y, Date to LPA 1 O Date Returned <br />FHWA Signatures Required? Y Of Y, Date to FHWA Date Returned <br />* Field Engineer Recommendation (Required for SCE or DDCM Approval) <br />Field Engineer Date <br />Comments: <br />