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~, FACILITY MANAGEMENT CHANGE ORDER ROUTING FORM <br />~rw <br />Date: October 1, 2004 <br />j Contract No.: 2005-03814 <br />Change Order No.: One <br />GJN: 3825 <br />Assessable? No <br />~o; X Mike Penwei I For: X Initials <br />X Glen Svendsen ~~%±~ Initials Signature <br />X Mark Schoening, City Engineer _~-Iflit:irtls ~ Signature <br />--~- - <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: The Murphey Harris Company <br />;Title: Amtrak Station. Eugene Depot - Cablina Devices <br />!Type: PI Project Manager:Russ Mecredy <br />I <br />Begin Date: Review Date: Termination Date: <br />Purpose of Change Order: Change to Scope of Work. Miscellaneous data and cabling changes. Facility <br />j located at 433 Wllamette Street. Increase to contract sum $679.00. <br />Budget Information: REQ. No. Date <br />Amount: $679.00 increase P.O. No.: <br />Authorization by: _ Debbie Clark / Peggy Hamlin <br />Line 1 Acct. Code: 311-9336-61739-905173 Amount: $679.00 <br />Line 2 Acct. Code: Amount: $ <br />Line 3 Acct. Code: Amount: $ <br />Line 4 Acct. Code: Amount: $ <br />`~ ~~ ~_ ~~ ~ , ~~11 /U~ TA~L C`O_NTRACT 5,614.00 <br />Note: Purchasing -- Please forward contract to CRO <br />By <br />Route form (Revised April 2003) <br />i~~-i i-)~ra~_''~: 'iLVU <br />