HomeMy WebLinkAboutCHANGE ORDER - PURCHASE ORDER - 9184173Change Order Form (for Work Orders)
Official Purchasing Form
Last updated 10/2017
CHANGE ORDER
NO. 03
PROJECT TITLE: L-Path Erosion Protection and Conceptual Design
CONTRACTOR: ICON Engineering, Inc.
WORK ORDER NUMBER: BLA-2018-01
PO NUMBER: 9184173
DESCRIPTION:
1. Reason for Change: Project Time
2. Description of Change: Final design for the Phase I and Phase II repairs not complete
Extension of completion date shown on Change Order No. 02
3. Change in Work Order Price: N/A
4. Completion Date (if changed): June 1st, 2020
ORIGINAL WORK ORDER PRICE $ 0.00
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 $ 0.00
CONTRACTOR: ICON Engineering, Inc.
By: Date:
Name: Title:
ACCEPTANCE: Date:
Beck Anderson, Civil Engineer II
REVIEWED: Date:
Marisa Donegon, Buyer II
ACCEPTANCE: Date:
Ken Sampley, Director, Civil Engineering
ACCEPTANCE: Date:
Theresa Connor, Deputy Director, Water Engineering & Field Services
DocuSign Envelope ID: F08E4044-B939-4A40-9637-1EACAB467668
December 19, 2019
December 20, 2019
Principal
December 20, 2019
Craig Jacobson
December 20, 2019
December 20, 2019