HomeMy WebLinkAboutCHANGE ORDER - REQUISITION - 23565JUN-10-2005 FRI 10:56 AM CFO ENG,
Fort Collim
Engineering Department
FAX N0, 9702216378
Change Order Form
PROJECT TITLE' Timberline Road Widening (Prospect to Drake)
PROJECT NUMBER: 30523270.6 (RFP #P-933)
CONTRACTOR: Interwest Consulting Group
CHANGE ORDER NUMBER: 3
n preparing change orders show in order as separate nurnbared paragraphs the o ovnng:
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 increase by $ 10,000.00
4. There will be no change In contract time.
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ORIGINAL CONTRACT COST
$183,949.00
TOTAL APPROVED CHANGE ORDERS
$160,336,60
TOTAL PENDING CHANGE ORDERS
$0.00
TOTAL THIS CHANGE ORDER
$10,000.00
TOTAL_ % OF THIS CHANGE ORDER ' I
5.44%
TOTAL C.O. % OF ORIGINAL CONTRACT
92.60%
ADJUSTED CONTRACT COST . ,-, '
$354,285.50
(Assuming all change orders approved)
ACCEPTED BY:
— --DATE:
ACCEPTED BY
REVIEWED BY
(Co ctor's Represen ti )
DATE:
(Project a er)
PATE:
(Engi eer)
ACCEPTED BY: ''� DATE:
(Department Head)
APPROVED BY: DATE:
(Purchasing Agent over $30,000)
co, Contractor
Purchasing
Project Re
~� Engineering Department - 281 North Colle%c Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (910) 221-6605