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CHANGE ORDER - REQUISITION - 30193
r rt; City of Fort Collins Engineering Department Change Order Form PROJECT TITLE: 2005 Street Maintenance Program PROJECT NUMBER: 320200 (Bid #5839) CONTRACTOR: Lafarge Northern, Inc. (PO #6602526) CHANGE ORDER NUMBER: 5 n preparing change orders show In order as separate numbered paragraphs the following: 1. Reason for change. 2. Description of change. 3. Change in contract cost. 4. Change in contract time. 1 &2. See attached sheet for detail. 3. The contract cost will decrease by $ (115,300,58) 4. There will be no change in contract time. ORIGINAL CONTRACT COST TOTAL APPROVED CHANGE ORDERS TOTAL PENDING CHANGE ORDERS TOTAL THIS CHANGE ORDER TOTAL % OF THIS CHANGE ORDER TOTAL C.O. °!o OF ORIGINAL CONTRACT ADJUSTED CONTRACT COST (Assuming all change orders approved) . ACCEPTED BY: (C ractor's Reprs REVIEWED BY: ( ngineer) SUBMITTED BY: (Project Manager) -4.10% -2.28% $2,810,339.30 $51,362.38 $0.00 ($115,300.58) $2,746,401.10 DATE: ''s ZIP ©�— ,TE: DATE: Zy cc) z APPROVED BY: \ ,U1fv\ 11 l LQ ; L,J y�ll �.t DATE: P� O '(Department Head) APPROVED BY: cc: Contractor Purchasing Project File DATE: Z Y Agent over $30,000) Engineering Department • 281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6605 City of Fort Collins 2006Asphalt Overlay Project Lafarge North America - Bid No. 5839 Change Order No.: 4 Date: 5/23/2007 1 Reason For Change: a. Reduce Contract Quantities to match Actual Quantities 2 Description Of Change: a. See Rectifying Change Order 3 Change in Contract Amount a. Reduced by a total of 115300.58 4 Change In Contract Time a. No time will be added to the Contract TOTAL CHANGE IN CONTRACT TIME Page 1 of ) 1 0 days