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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 118-110 Project Name: CIVIC Alleyway Repaving Change Order #: 1 <br />DATE INITIATED: 7/2/2019 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope Etc.). <br />Adjustment to Final Quantities from an Overrun of Drive Approach Quantities. <br />Attachments: (List documents support change — required) <br />Quantities Comparison Form. <br />Amount of®Increase /❑Decrease: $3,355.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $, 0___- ❑ Scope of Work <br />..° ❑ Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 6.62 _ % ❑ Conflicted Specifications and Drawings <br />El Failed Materials <br />.New Total Amo <br />.00 <br />unto $ 54047.,_,_.— ❑ Error <br />............................. El Omission <br />Total Percent of Change: 6.62 % <br />8 Final Quantity Adjustment <br />Funding Secured From: <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer 7/3/2019 <br />Project Inspector (Print Name) ('S'i atu (Date) <br />REVIEWED BY: <br />a <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />7VIA <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROV D BY: p <br />City Engineer (Print Name) (S�gn' tore) (Dale) <br />