08-153.00 Inland Asphalt: Pines-Mansfield Corridor Congestion Relief
Washington Sete h a n g e O e r
DepaMme~rt of 7Yansportation
W
Date 11/12/2008
Page 1 of 3 Pages
Contrad Number 08-016 Federal Aid Number CM-9932 (032)
Contract Title Pines-Manfield Corridor Congestion Relief Project
Change Order Number 4
Prime Contractor Inland Asphalt
M Ordered by Engineer under the terms of Section 1-04.4 of the Standard Specifications
❑ Change proposed by Contractor
Endorsed By , Surety Consent
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ConVacltR - a Attomey on Fact
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Original Contract Amount 3,061,916.95
Current Contract Amount 3,061,177.04
Estimated Net Change This Order -13,000.00
Estimated Contract Total After Change 3,048,177.04
Approval Required ❑ Region ❑ Olympia Service Center Z Local Agency
If the amount authorized in the Local Agency Agreement is exceeded and federal funds are not available for this
change, the Local Agency will assume the total cost of this Change Order.
~ Approval Recommended Ej Approved Approved
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Pmiect Engineer~ AppmWn9 ANhoriy Per C.A. A9reemeM
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Date Dffie
F-I Approval Rewmmended ~ Approved Other Apprbval When Required
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Dale RepreserNng
)OT Fortn 140-005 EF
Revised 10/87
C08-153
CHANGE ORDER
Page 3 of 3
Contract No: 08-016 Change Order No. 4
Item No. Item Description Unit Unit Price Est. Qty. Est. Amt.
Measure Change Change
New Change Order #4 - Roundabout Illumination LS -$13,000.00 1 -$13,000.00
Deletion
TOTAL -S13,000.00