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Contract No:B -44292 <br />INDIANA Department of Transportation <br />Construction Change Order and Time Extension Summary <br />Review and Approval Information <br />Required Approval Authority <br />($ per Change Order) <br />(Days per Contract) <br />Verbal Approval Required? <br />Total Change To-Date>5%? <br />Scope/Design Recommendation <br />Required? <br />Change Order No.: 005 <br />Page: 2 <br />AE: DCE: ✓ SGE-: * DDCM <br />(-LE$250K-) (-LE$750K-) (--LE$2M--) (--GT$2M--) <br />( 50 SS days) ( 100 SS days) ( 200 SS Days ) ( GT 200 SS days) <br />ON If Y, by S.Hauersperger Date Issued 01/02/24 <br />Y / N If Y, Copy to Program Budget Manager <br />- <br />Y / N If Y, Referred to Project Manager(PM) _ <br />Date to PM Date Returned <br />Approval Authority Concurs with PM? 0 N If Y, Concurrence by .LKrueckeburg ^ Date 01/08/24 <br />If N,Resolution: Approved _ Disapproved <br />Resolved by Date <br />LPA Signatures Required? CD N If Y, Date to LPA 01/08/24 Date Returned <br />FHWA Signatures Required? Y 0f Y, Date to FHWA Date Returned <br />* Field Engineer Recommendation (Required for SCE or DDCM Approval) <br />Field Engineer Date <br />Comments: <br />