HomeMy WebLinkAbout1 - Original Submission_ CO 1 Add Alt 1_City Funded SignedWSDOT Form 140-005 Revised 04/2015
Page 1
Change Order
Contract Number Contract Title Federal Aid Number
Change Order Number Change Description Date
Prime Contractor / Design-Builder
Ordered by Engineer under the terms of Section 1-04.4 of the Standard Specifications
Change proposed by Contractor / Design-Builder
Change Description
Verbal Approval Given By Verbal Approval Date Working Days +/-
Original Contract Amount Current Contract Amount Est. Net Change This C.O.Est. Contract Amount
Approval Recommended Approved
Project Engineer
Date
Approved
Approving Authority per C.A. Agreement
Date
Approval Recommended
By Prime Contractor
Date
Other Approval As Required
Signature Date
Representing
Andrea Archer-Parsons
8/13/21
315023 Kitsap Way and Warren Ave Traffic Signal & Multimodal 000S(525)
1 Adding Alternate #1 - Kitsap Way/11th Street Raised Median 8/12/21
Active Construction, Inc.
The City is adding Active Construction's Bid Alternate #1 - Kitsap Way/11th Street Raised Median to the
Contract at the bid price of $163,575.00.
0
$2,324,998.00 $2,324,998.00 $163,575.00 $2,488,573.00
DocuSign Envelope ID: 72FAB56A-B25C-4F0E-AF0A-74B96BCC223A
8/18/2021
Asst. City AttorneyBremerton8/20/2021
Active Construction, Inc.
8/23/2021
Mayor
WSDOT Form 140-005 Revised 04/2015
Page 2
Contract Number Contract Title Change Order Number
Change Description Cont.
315023 Kitsap Way and Warren Ave Traffic Signal & Multimodal 1
DocuSign Envelope ID: 72FAB56A-B25C-4F0E-AF0A-74B96BCC223A