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Contract No:R -39540 <br />Change Order No:004 <br />INDIANA <br />Department of Transportation <br />Date:09/29/2020 <br />Contract: R -39540 <br />Project: 1600074 - State:160007400LC4 <br />Change Order Nbr: 004 <br />Change Order Description: Added Traffic Signal Head & Light Pole Work <br />Reason Code: ERRORS & OMISSIONS, Spec Related <br />CLN PCN PLN Item Code Unit Unit Price CO Qty Comment Amount Change <br />Page: 3 <br />0150 1600074 0150 105-06807 LS 1,592.850 1.000 C Amcurt:$ 1,592,85 <br />Item Description: ADDITIONAL <br />Supplemental Descrlption1: Traffic Signal Head Visor and Ught Pole Banner Arm Work <br />Supplemental Description2: <br />Total Value for Change Order 004 = $1,592.85 <br />Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change is recommended. <br />General or Standard Change Order Explanation <br />The City of South Bend requested that the traffic signal head visors be changed for the Rockne Df, eastbound signals. New visors were provided <br />by the City. The cost to do this work was $565.19. The City of South Bend also requested that the light pole banner mounting brackets be <br />removed from the light poles. The cost to do this work was $1,027.66. <br />Change Order Explanation for Specific Line Item <br />1T1YfftTRY##Y#1rtYf#Y/Yt •f!Y/f a f!Y•fiYYffM f##f f Yf /f ff •!#/Rf iff f-fY##Y##ftiNYNYHitx#t11 k#Y#f Yi#Rf ffR#MY#f### #HY###Ytt Y#tvY <br />It is the intent of the parties that this change order is full and complete compensation for the work describe above. <br />Notification and consent to this change order is hereby acknowledged. / <br />Contractor: 1 Cr Signed By: )C <br />Date: 36 - Zo <br />NOTE: Other required State and FH WA signatures will be obtained electronicaily through the SkeManager system. <br />