09-205.00 Inland Asphalt: Pines-Mansfield Corridor Congestion ReliefWashington State
Department of Transportation
Contract Number 08 -016 Federal Aid Number
Contract Title Pines - Manfield Corridor Congestion Relief Project
Change Order Number 33
Prime Contractor Inland A
Change Order
Date 8/12/2009
Page 1 of 3 Pages
CM -9932 (032)
® Ordered by Engineer under the terms of Section 1 -04.4 of the Standard Specifications
❑ Change proposed by Contractor
Endorsed By Surety Consent
Contra V Attorney an Fad
C"
D>eta Date
Original Contract Amount
Current Contract Amount
Estimated Net Change This Order
Estimated Contract Total After Change
3,061,916.95
3,310,779.72
10,332.00
3,321,111.72
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.
C Approval Recommended Approved
Approv d
Project Engineer
Approving Autho Pe C.A. Agreement
Date
Date
Approval Recommended Approved
Other Approval When Required
By
Signature Data
Date
Representing
DOT Form 140 -005 EF
Revised 10/97
Coq - q00
CHANGE ORDER
Page 2 of 3
Contract No: 08 -016
This Contract is revised as follows:
Description of Work
Change Order No. 33
This Change Order compensates the Contractor for costs incurred due to the need for
24 -hour traffic control during construction of the east leg of the Pines - Mansfield
intersection.
Payment
Payment shall be made for the following items:
New contract item:
'Traffic Control Equipment', Lump Sum
Contract Time
Contract time will not be adjusted as a result of this Change Order.
CHANGE ORDER
Page 3 of 3
Contract No: 08 -016
Item No. I Group No.
Item Description
NEW 6 Traffic Control Equipment
Change Order No. 33
Unit I Unit Price I Est. Qty. Est. Amt. Change
Measure Chanoe
LS $10,332.00 1 $ 10,332.00
TOTAL $10,332.00