HomeMy WebLinkAboutCORRESPONDENCE - BID - 8722 FOAM INJECTION PAVEMENT LIFTING PROJECT (2)Change Order Form (for Work Orders)
Official Purchasing Form
Last updated 10/2017
CHANGE ORDER
NO. 1
PROJECT TITLE: Foam Injection
SERVICE PROVIDER: Northern Colorado Mud Jacking
WORK ORDER NUMBER: STS 2019-01
PO NUMBER: 9191081
DESCRIPTION:
1. Reason for Change: We identified many more locations when we responded to residents’
complaints of tripping hazards throughout the City.
2. Description of Change: Added various locations that need leveling due to trip hazards.
3. Change in Work Order Price: $30,000.00
4. Change in Work Order Time: 0
ORIGINAL WORK ORDER PRICE $ 100,000.00
TOTAL APPROVED CHANGE ORDER $0.00
TOTAL PENDING CHANGE ORDER $ 30,000.00
TOTAL THIS CHANGE ORDER $130,000.00
TOTAL % OF THIS CHANGE ORDER 30%
TOTAL C.O.% OF ORIGINAL WORK ORDER 30%
ADJUSTED WORK ORDER COST $ 130,000.00
SERVICE PROVIDER: Date:
Jeremy Bair
ACCEPTANCE: Date:
Angel Ontiveros, Project Manager
REVIEWED: Date:
Elliot Dale, Senior Buyer
ACCEPTANCE: Date:
Gerry Paul, Purchasing Director
(if greater than $60,000)
DocuSign Envelope ID: 5B798C5A-1325-475F-A112-4C4FCBE198F1
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