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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 1 18-046R Project Name: VPA MAINTENANCE STORAGE BUILDING Change Order #: 5 <br />DATE INITIATEMC?.M5/28i1M9 � ........�.� BPW DATE: mm <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Deduct resulting from not doing pavement striping. <br />Attachments: (List documents support change - required) <br />AIA G701-2017 <br />Amount of ❑ Increase / ® Decrease: $ 396.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 59,206.00 ❑ Scope of Work <br />10 B Differing Site Conditions, Changed Conditions <br />Current Percent of Change: % ❑ Conflicted Specifications and Drawings <br />388,984.00 ❑ Failed Materials <br />New Total Amount: $❑ Error <br />............... <br />.81 ❑Omission - <br />17 <br />Total Percent of Change: % ❑ Final Quantity Adjustment <br />Funding Secured From: _ 0 <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer ,"- '1113W iOPe° 6/4/19 <br />u Y9Vk <br />v ltl,5mn pu ru mni 8ba i'N <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />CA <br />®t <br />Construction Manage (Print Name) (Signature) - (Date) <br />APPROVED B� L ................ <br />Y.: <br />4 B A <br />Engineering Pru,i ' t Manager (Print Name) (Signature) V (Date) <br />APPROVED BY: <br />m <br />City Engineer (Print Name) (Signature) (Dte <br />