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�1 , <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />118-080A 05MIMAt WASHNG�7a��� N,C0r��AX ROOF I MPROVEME.Nt^ 1 <br />Project Number: ,Project Name: Change Order #: <br />DATE INITIATED: 11/30/2018 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Deck and Rafter Repairs on Roof. <br />Attachments: (List documents support change - required) <br />Contractor cost email. <br />Amount of B Increase / ❑ Decrease: $ 4,475.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 8 Scope of Work <br />-......-_ ❑Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 3.47 <br />❑ Conflicted Specifications and Drawings <br />5.00 ❑Failed Materials <br />New Total Amount: $ ❑ Error <br />....... ............. <br />_. -. <br />❑ Omission <br />Total Percent of Change: 3.47 <br />❑ Final Quantity Adjustment <br />Funding Secured From: 4"-2-'tQ50 * LA fo0 - 4Z.03 <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer 8/14/19 <br />Project Inspector (Print Name) (Signs/ �69 (Date) <br />REVIEWED BY: <br />p ® b <br />i� <br />Construction Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Ic, <br />t <br />Engineering Project Manager (Print Name) (Signs e) (Date) <br />APPROVED BY: <br />City Engineer (Print Name) (Signatc� )" (Date <br />