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STATE AID FOR LOCAL TRANSPORTATION June 2008 <br /> CHANGE ORDER Page2of2 <br /> Estimated Change in Cost <br /> Item No. Item Name Unit Quantity Unit Price Amount <br /> DECREASE FOR FAILING CONCRETE <br /> MATERIAL LS 1 ($1,102.25) ($1,102.25) <br /> DECREASE FOR FAILING CONCRETE <br /> MATERIAL LS 1 ($483.60) ($483.60) <br /> TOTAL ($1,585.85) <br /> 100 % Group 1 <br /> CHANGE IN CONTRACT TIME (check one) <br /> Due to this change, the Contract Time: <br /> a. ❑ Is Increased by Working Days b. ® Is Not Changed <br /> ❑ Is Decreased by Working Days <br /> c. ❑ May be revised if work affected the <br /> ❑ Is Increased by Calendar Days controlling operation <br /> ❑ Is Decreased by Calendar Days <br /> Approved by Approved <br /> City: Contractor: <br /> Print Name: Print Name: re,k Si - 4-1 <br /> Date: Phone: Date: 2 / 2. /f 2 Phone: <br /> Concurrence by <br /> Anoka County: <br /> Print Name: <br /> Date: Phone: <br /> Original to City Engineer, County Engineer, Contractor; Copy to MnDOT <br /> Once contract has been fully executed, forward a copy to DSAE for funding review <br /> The State of Minnesota is not a participant in this contract, signing by the District State Aid <br /> Engineer is for FUNDING PURPOSES ONLY. Reviewed for compliance with State and Federal <br /> Aid Rules /Policy. Eligibility does not guarantee funds will be available. <br /> This project is eligible for: — Federal Funding State Aid Funding _ Local funds <br /> District State Aid Engineer: Date: <br /> 18 <br />