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zap° ro 044, <br />DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />117-031 R wat"' works No"h PuffNp t,U Swats°n w°ua placema,•t 3 <br />Project Number: Project Name: Change Order #: <br />DATE INITIATED: 11/7/19 <br />BPW DATE: <br />Brief Summary of Change Order; (Construction Change, Alternative, Substitution, Differing Instructions, Out of Scope, Etc.). <br />Provide & Install a V1 K Open Enclosure, dV/dT Output Filter in the MCC bucket as identified and <br />requested by City of South Bend Water Works <br />staff. <br />Attachments: (List documents support change — required) <br />Contractors Cost. <br />Amount ofeIncrease /❑Decrease: $3,988.00 <br />Categories (Pick One): <br />Previously approved Change Order(s): $ 10,807.72 <br />8 Scope of Work <br />8 Differing Site Conditions, Changed Conditions <br />Current Percent of Change:.73 % <br />❑ Conflicted Specifications and Drawings <br />....... ..................................._........��..._..........................................._._.www <br />New Total Amount: $ 547,558.72 <br />❑Failed Materials <br />❑ Error <br />2 78 <br />I] Omission <br />Total Percent of Change: % <br />❑ Final Quantity Adjustment <br />Funding Secured From: r 1 1 <br />0 <br />(filled out by PM) woex <br />RECOMMENDED BY: <br />Josh Ehmer <br />'a 4, <br />11/7/2019 <br />Project Inspector (Print Name) <br />(Signature (Date) <br />REVIEWED BY: <br />, <br />Construction Manager (Print Name) <br />(Signature) (Date) <br />APPROVED BY: <br />.►l�y�� <br />Engineering Project Manager (Print Name) <br />(Signature) (Date) <br />APPROVED BY: <br />.. "�AAIVN) <br />f C <br />City Engineer (Print Na 7e) <br />(Signatu e) (Da e) <br />