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y,WD4 Fop A`u,� , <br />0 k <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />kJE9 <br />Project Number: 118-086R Project Name:: Liberty Tower Improvements DivC Change Order #: 4 <br />DATE INITIATED:9/13/19 BPW <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope Etc.). <br />Provide Interior Vestibule Wall Surrounding CW7 (Door #04), per owner Direction. <br />Attachments: (List documents support change — required) <br />Contractors cost. <br />_........._. _............ .. <br />Amount of ® Increase / ❑ Decrease: $ 2975.31 <br />Categories (Pick One): <br />Previously approved Change Order(s): $1805.77 8 Scope of Work <br />.................................................... 8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 97., % ❑ Conflicted Specifications and Drawings <br />.. .... <br />New Tot <br />308,781 .0$ � El Failed Materials <br />al Amount: $ IT........._.. ......... _ ❑Error <br />1.57 El Omission <br />Total Percent of Change: % ❑ Final Quantity Adjustment <br />Funding Secured From: �?ZW —►C50 - 4Go-yZ-02 <br />(filled out by PM) <br />RECOMMENDED BY: <br />Josh Ehmer,, , 9/16/19 <br />Project Inspector (Print Name) (Signatu µ (Date) <br />REVIEWED BY: <br />Construction Mana er (Print Name) (Signature)CT (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signa e) (Date) <br />APPROVED B'Y: <br />f l <br />J4��' <br />City Engineer (Print Name) (') � <br />i na ur (DaW <br />