09-101.00 Inland Asphalt: Pines Mansfield Congestion Relief
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Washington State
v7PDepartment of Transportation Change Order - Minor Change
Contract Number Contract Title Federal Aid Number
TA-2942 Pines-Mansfield Corridor Congestion Relief Project CM-9932(032)
Change Order Number Change Description Date
28 Reconstruct sewer manhole Montgomery May 21, 2009
Region Project Engineer Phone Number
Eastern Region Steven M. Worley 509-688-0198
Prime Contractor
Inland Asphalt Company
0 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
The Contractor shall relocate the existing sweer manhole at approximately P 24+50 LT by removing the cone and
adjustment rings, installing a flat top cover, rotating the access hole 180 degrees, then adjusting it back to final
grade.
Payment
The lump sum amount of $1,578.63 shall be full pay for all labor, equipment and materials to perform the work
specified. .
Contract Time
One (1) working day will be added as a result of this Change Order.
All work, materials and measurements to be in accordance with the provisions of the Standard Specifications and Special
Provisions for the type of construction involved unless stated otherwise in this document.
Original Contract Amount Current Contract Amount Est. Net Change This C.O. Est. Revised Contract Amount
$ 3,061,916.95 $ 3,257,625.00 1,578.63 $ 3,259,203.63
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Prime Contractor Signature or ~ c ► j
Date
Method of Concurrence:
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Project Engineers Signature for Execution: Date 61
Distribution: Original w/Attachments - Steven M. Worley
Copy of page 1 only w/o Attachments - Inland Asphalt Company Page 1
Copy w/o Attachments - ER Construction Office
DOT Form 421-005A EF Copy w/o Attachments - State Construction Office
Revised 4/2002