09-008.00 Inland Asphalt: Pines Mansfield Congestion Relief
AdMk ~ Washington'Uiate
Department of Transportation Change Order - Minor Change
Contract Number Contract Title Federal Atd Number
TA-2942 Pines-Mansfield Corridor Congestion Relief Project CM-9932(032)
Change Order Number Change Description Date
12 Concrete Intersection Tie-In Jan 5, 2009
Region Project Engineer Phone Number
Eastern Region Steven M. Worley 509-688-0198
Prime Contractor
Inland Asphalt Company
N Ordered by Engineer under the terms of Section 1-04.4 of the Standard Specifications
❑ Change proposed by Contractor
Change Description
The General Special Provisions for this project are supplemented as follows: ,
Description
Perform additional saw cut and pavement removal, as well as backfilling with controlled density fill (CDF) for the
area between the concrete intersection and the remaining existing asphalt.
Payment
The lump sum amount of $768.40 shall be full pay for all labor, equipment and materials to perform the work
specified.
All work, materials and measurements to be In accordance with the provisions of the Standard Speclflcations and Speciel
Provisions tor the type of conetrucdon involved unless stated otherwise In this document
Original Contract Amount Current Contract Amount Est Net Change This C O Est Revised Contract Amount
$ 390619916.95 $ 391549529.73 $ 768.40 $ 33,1559298.13
Prime Contractor Signature or w `
Method of Concurrenoe Date~JPA , QS ZO°L
t
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Project Engineer's Signature for Execwtion ~ Date 22 a7
Distribution Original w/Attachments - Steven M Worley Pe 1
Copy of page 1 only w/o Attachments - Iniand Asphalt Comparry 9e
Copy w/o Attachments - ER Construcbon Office
DOT Fomt 421-005A EF Copy w/o Attachments - State Construction Oftfce
Rev(W 4/2002
C09-008