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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />117-120A Project Name: Change Order #: <br />Mishawaka Avenue Traffic Signals at Fire Station #9 1 <br />Project Number: <br />DATE INITIATED:6-13-19 m.... BPW DATE: 7-9-19 ........ <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Intersection at Mishawaka Ave/Ironwood Dr. is not up to date. Handholes to be added at each <br />corner with independent conduit runs to each. Additional concrete work needed to tie everything <br />together properly. <br />Attachments: (List documents support change — required) <br />Price breakdown <br />Amount of B Increase / ❑ Decrease: ¶16, 638.57 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 0.00 ® Scope of Work <br />............................ .....••••••-...... 8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 9.71 ........ % ❑ Conflicted Specifications and Drawings <br />New........ �.....,....�,,,,.. �ww..._.� <br />El Failed Materials <br />Total Amount: $187,923.94 El Error <br />❑ Omission <br />Total Percent of Change: 9'71 <br />❑ Final Quantity Adjustment <br />,� L7 <br />Funding Secured From: • • ................ <br />(filled out by PM) <br />RECOMMENDED BY: <br />Dan Jones <br />Project Inspector (Print Name) (Signature) (Date) <br />REVIEWED BY: <br />Toy Villa 27 . <br />Construction Manager (Print Name) _. _. (Signature) Y n WWXITITITWWWWmmmIT� (Date) <br />APPROVED BY: <br />Roger Nawrot <br />-- <br />Engineering Project Manager (Print Name) Sig ire) (Date) <br />APPROVED BY: <br />Kara Boyles <br />City Engineer (Print Name) (Signature) (C1 te) <br />