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<br /> <br />FACILITY MANAGEMENT CHANGE ORDER ROUTING FORM <br />4 <br />Date: October 1, 2004 <br />Contract No.: 2005-03814 <br />Change Order No.: Two <br />GJN: 3825 <br />Assessable? No -- <br />X Mike Penwel I For: .-x- Initials <br />To: <br />X Glen Svendsen i 1~ Initials Signature <br />___X.- Mark Schoening, City Engineer ~-- ~ Signature <br />Initials `~-=--~~a <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 Mur{~g arri~,. omDa <br />Title: Relocate Bunkhouse at Euaene Depot Site <br />Type: PI Project Manager:-R.~-ss-A~cre~~~ <br />Begin Date: Review Date: Termination Date: <br />Purpose of Change Order: Change to Scope of Work. Misc. increase to work including service call. <br />Facility located at 433 Willamette Street. Increase to contract sum $391.00. <br />Budget Information: REQ. No. Date By <br />Amount: $391.00 increase P.O. No.: <br />Authorization by: Debbie Clark / Peggy Hamlin <br />~" <br />Line 1 Acct. Code: <br />Line 2 Acct. Cade: <br />Line 3 Acct. Code: <br />Line 4 Acct. Code: <br />311-9336-61739-905173 <br />Amount: $391.00 <br />Amount: $ <br />Amount: $ <br />Amount: $ <br />TOTAL CONTRACT $6, D05.00 <br />Note: Purchasing -Please forward contract to CRQ <br />Route form (Revised ~ 5-'~-~'"~ ~`' ~ VZ. ~ ~ ~/ <br />aprii 2003) ~--~ I I ~~ J U _ f ! _ ,) / ,~ n ~^ . - _, <br />/ • JJ .`~~~ ~~Q <br />