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HomeMy WebLinkAboutCHANGE ORDER - BID - 7417 ASPHALT SURFACE TREATMENT PROJECTCHANGE ORDER FORM PROJECT TITLE: Street Maintenance Slurry Program PROJECT NUMBER: Bid #7417 PO #9124934 CONTRACTOR: Al Chipseal Co CHANGE ORDER NUMBER: 1 In 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. Increase in quantities 2. Add 366 sq yds of cape seal 3. Increase PO by $2,559.17 4. No change. ORIGINAL CONTRACT COST TOTAL APPROVED CHANGE ORDERS TOTAL PENDING CHANGE ORDERS TOTAL THIS CHANGE ORDER TOTAL % OF THIS CHANGE ORDER TOTAL C.O. % OF ORIGINAL CONTRACT ADJUSTED CONTRACT COST (Assuming all change orders approved) ACCEPTED[ SUBMITTED (Project Manager) REVIEWED BY: Engineer) APPROVED BY: (Department Head) cc: Accounting Contractor Purchasing Project File 9.44 9.44 $27,103.20 $0.00 $0.00 $2,559.17 $29,662.37 DATE: DATE: TE: DATE: / /oZ(0 /42