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a, DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />Project Number: 118-043R Project Name: VPA Restr worn Remodeling Change Order #: 3 <br />DATE INITIATED: 10/15/19 BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Replace main shut-off valve at Vet's Memorial- $3,390 <br />Miscellaneous unforeseen costs at Rum Village and Pinhook- $668 <br />Unforeseen delays- Extend completion to 10/11/2019 <br />Attachments: (List documents support change - required) <br />Contractor's cost explanations and time extension request. <br />Amount of BIncrease/ ❑Decrease: $ 4058 <br />"""""' Categories (Pick One): <br />Previously approved Change Order(s): $ 35250.82 B Scope of Work <br />.- - El <br />Site Conditions, Changed Conditions <br />Current Percent of Change: 0'77 % ❑ Conflicted Specifications and Drawings <br />.. ❑Failed Materials <br />New Total Amount: $ 529, 308.82 <br />❑ Error <br />❑ Omission <br />Total Percent of Change: 8.02 <br />❑ Final Quantity Adjustment <br />Funding Secured From <br />(filled out by PM) <br />RECOMMENDED BY: <br />rr <br />Project Inspector (Print Name) iiegnature) (Date) <br />REVIEWED BY: <br />Construction Man ger (Print Name) (Signature) (Date) <br />APPROVED BY: <br />Engineering Project Manager (Print Name) (Signature) (Date) <br />APPROVED BY: <br />City Engineer (Print Name) (Signature) (Date) <br />