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.A <br />FACILITY MANAGEMENT CHANGE ORDER ROUTING FORM <br /> <br />Date: January 7, 2004 <br /> Contract No.: 2004-03841 <br /> Amendment No.: ~ ~ ~ <br /> GJN: 3825 <br /> Assessable? No <br />To: X Mike Penwel I For: X Initials <br />X Glen Svendsen X Initials Signature <br />X Mark Schoening, City Engineer X Initials Signature <br />~_ Kurt Corey, Public Works Dir. Initials ~ _ Signature <br />Dennis M. Taylor, City Manager For: Signature <br />Please return to Hamilton at Facility Mgt X Send PO to Clark at PWA <br />Contractor: Chris Schoap Building Movers <br />~,,~ Title: Relocate Bunkhouse at Eugene Dec~ot Site <br />Type: PI Project Manager: R~,~S M ..redv <br />Begin Date: Review Date: Termination Date: <br />Purpose of Change Order: Change to Scope of Work. Delete covering roof with plastic sheeting and <br />cover with "wafer-board" placed shingle-style and secured with screws to framing. Facility located at 433 <br />Willamette Street. Increase to contract sum $360.00. <br />~ooLlo503\q Date /lq`d~ B <br />Budget Information: REQ. No. Y <br />Amount: $360.00 increase P.O. No.: ~~~ ~ j t~ 2 ~ ~ ~ <br />~~~~ <br />Authorization by: Debbie Clark / Peggy Hamlin ~ <br />Line 1 Acct. Code: <br />Line 2 Acct. Code: <br />Line 3 Acct. Code: <br />Line 4 Acct. Code: <br />311-9336-61739-905173 <br />®~ Amount: $360.00 <br />Amount: $ <br />Amount: $ <br />Amount: $ <br />1~°I I040TAL~ NTRAC:T ~6,s60.00 <br />~,..~ ~, 'Pu•rc4t~vt~ <br />Note: Purchasing -- Please forward contract to CRO <br />01-09-04A10:~1 RCVD <br />Route form (Revised April 2003) <br />