HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9190265Change Order Form (for Work Orders)
Official Purchasing Form
Last updated 10/2017
CHANGE ORDER
NO.
PROJECT TITLE:
SERVICE PROVIDER:
WORK ORDER NUMBER:
PO NUMBER:
DESCRIPTION:
1. Reason for Change:
2. Description of Change:
3. Change in Work Order Price:
4. Change in Work Order Time:
ORIGINAL WORK ORDER PRICE $
TOTAL APPROVED CHANGE ORDER $
TOTAL PENDING CHANGE ORDER $
TOTAL THIS CHANGE ORDER $
TOTAL % OF THIS CHANGE ORDER %
TOTAL C.O.% OF ORIGINAL WORK ORDER %
ADJUSTED WORK ORDER COST $
SERVICE PROVIDER: Date:
, Title
ACCEPTANCE: Date:
, Project Manager
REVIEWED: Date:
, Buyer or Senior Buyer
ACCEPTANCE: Date:
Gerry Paul, Purchasing Director
(if greater than $60,000)
DocuSign Envelope ID: 2C95C316-11D3-4D67-9849-FA8B48869B83
1
12,230.00
repair bills paid to PO instead of separately
17,333.26
42
919026
amendment to PO for repair bills
na
5103.26
Jill Wuertz
amendment to PO for repair bills
Police Services Maintenance
October 4, 2019
5,103.26
Jody Medrano
CoCal Landscape Services
October 8, 2019
General Manager
October 8, 2019
Elliot Dale
Requested Change Order by Parks
Amend Police Services maintenance contract to include repair bills previously paid below:
Date Invoice # Amount
8/14/2019 17376 $442.16
9/9/2019 18127 $328.63
9/19/2019 18393 $482.47
9/30/2019 18867 $3,850.00
TOTAL $5,103.26
. . . . . . . . . . . . . . .
JILL WUERTZ, PLA, CPRP, CPSI
Senior Specialist – Parks Life Cycle Program
City of Fort Collins
413 S Bryan Avenue
970-416-2062 office
970-219-1573 mobile
jwuertz@fcgov.com
DocuSign Envelope ID: 2C95C316-11D3-4D67-9849-FA8B48869B83