CHANGE ORDER NO. 01
Printed: 10/12/2022 Page 1 of 1
Prepared By: MH
CITY OF FORTUNA
CONTRACT CHANGE ORDER REQUEST/AUTHORIZATION
DATE SUBMITTED: 10/17/2022
PROJECT NAME: Clean up and Outreach Services
CONTRACTOR NAME: River Life Foundation
CHANGE REQUESTED BY: [ X ] CITY [ ] CONTRACTOR NAME AND TITLE: _____________________________ The following described changes are requested for the above-named project:
The requested change is an additional $5,000 added to the budget for this project.
This change order results in:
1. A(n) [ X ] increase [ ] decrease [ ] no change of $5,000 to the contract amount.
The new contract amount is $15,000.
2. A(n) [ ] increase [ ] decrease [ X ] no change of 0 days to the time of completion.
The new date of completion is:
If accepted by Contractor, Contractor agrees that if this CCO is authorized by the City, that Contractor will perform all work necessary to complete the work as described in this change order, and accept as full payment the amount shown. All other terms and conditions of the original contract shall remain in effect.
Contractor [ ] accepts [ ] rejects this CCO. Signed: ____________________________ Title: ______________________________ Date: ______________________________ Public Works Dept [X] accepts [ ] rejects this CCO. Signed: ____________________________ Date: ______________________________
City hereby authorizes the work as described in this change order, and agrees to pay the amount shown for the work. _____________________________________ Date: _______________________________ Merritt Perry
City Manager