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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8073 ENGINEERING SERVICES FOR WATER, WASTEWATER & STORMWATER FACILITIES CAPITAL IMPROVEMENTS PROJECTS (5)Change Order Form (for Work Orders) Official Purchasing Form Last updated 10/2017 CHANGE ORDER NO. 01 PROJECT TITLE: West Vine Basin Floodplain Update – Phase II CONTRACTOR: ICON Engineering, Inc. WORK ORDER NUMBER: BLA-2019-04 PO NUMBER: 9191204 DESCRIPTION: 1. Reason for Change: Time 2. Description of Change: Delivery of preliminary submittal and review of hydraulic model and floodplain mapping has not been completed. Proposed change to original work order completion date of December 31st, 2019. 3. Change in Work Order Price: N/A 4. Completion Date (if changed): April 24th, 2020 ORIGINAL WORK ORDER PRICE $ 0 TOTAL APPROVED CHANGE ORDER 0.00 TOTAL PENDING CHANGE ORDER 0.00 TOTAL THIS CHANGE ORDER 0.00 TOTAL % OF THIS CHANGE ORDER 0% TOTAL C.O.% OF ORIGINAL WORK ORDER 0% ADJUSTED WORK ORDER COST $ 0 CONTRACTOR: ICON Engineering, Inc. By: Date: Name: Craig Jacobson Title: Principal ACCEPTANCE: Date: Beck L. Anderson, Project Manager REVIEWED: Date: Pat Johnson, Senior Buyer ACCEPTANCE: Date: Ken Sampley, Director, Civil Engineering ACCEPTANCE: Date: Theresa Connor, Deputy Director, Water Engineering & Field Services DocuSign Envelope ID: 99FA3CB2-C283-4999-8158-F421E6680AD6 December 19, 2019 December 20, 2019 December 20, 2019 December 20, 2019 December 20, 2019