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Project Number: 118-056 <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Name: Pulaski Park Improvements Change Order #: 1 � N <br />J 9 <br />DATE INITIATED: 10/03/2019 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Miscellaneous credits and charges due to unforeseen conditions and scope changes. <br />ste d f t�rrd�d� Wit" �'a�t <br />Attachments: (List documents support change — required) <br />Request log of all credits and charges and individual explanations. <br />Amount of Blncrease / ❑Decrease: $ 2,284.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $, 0 8 Scope of Work <br />El Differing Site Conditions, Changed Conditions <br />Current Percent of Change: 0'26 <br />❑ Conflicted Specifications and Drawings <br />............... <br />❑ Failed Materials <br />New Total Amount: $ 880,970.25 <br />❑ Error <br />❑Omission <br />Total Percent of Change: 0.26 <br />❑ Final Quantity Adjustment <br />Funding Secured From: �152-��o1-N52.�1-efo <br />�m <br />(filled out by PM) <br />RECOMMENDED BY: <br />Greg McGowan <br />Project Inspector (Print Name) Signature) (Date) <br />REVIEWED BY: <br />Construction alVl Hager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signs e) (ate) <br />APPROVED BY: <br />IL <br />City Engineer (PrintName) (Sign l7l I F (Dal <br />