Laserfiche WebLink
DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: <br />116-082C Project Name: Miami Basin improvements Change Order #: 3 <br />DATE INITIATED: 7/2/19 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Repair 2-6" PVC Storm Lines ($1,975). Lower 2" Conduit ($1,035). <br />Attachments: (List documents support change — required) <br />Contractor Pricing. <br />... _........ <br />. <br />Amount ofeIncrease /❑Decrease: $3,010.00 <br />_.—._._..................._......._._._.._ Categories (Pick One): <br />Previously approved Change Order(s): $ 8,780.00 ❑ Scope of Work <br />® Differing Site Conditions, Changed Conditions <br />Current Percent of Change: '6 % ❑ Conflicted Specifications and Drawings <br />504 790 00 El Materials <br />New Total Amount: $......................:.......................... ❑ Error <br />❑ Omission <br />Total Percent of Change: 2.39 .. .......... % ❑ Final Quantity Adjustment <br />Funding Secured From; E7 _ ITITITIT " _.. <br />(filled out by PM) mmIT <br />RECOMMENDED BY: <br />Josh Ehmer 7/26/19 <br />Project Inspector (Print Name) (Sirgnatu (Date) <br />REVIEWED BY: <br />®`t <br />Constru=6BY" <br />eager (Print Name) (Signature) (Date) <br />APP't�: ,„,... <br />En i ring Project Managr (Print Name) (Signature) (Date) <br />APPRONED BY: <br />(SCit Engineer (Prin Name' o na e) <br />