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CHANGE ORDER
OWNER City of Renton
CITY OF RENTON CONTRACTOR Northwest Playground
Project Name Windsor Hills Park Play Area Site Work
Project Address 435 Windsor Way NE
Renton,WA 98055 Date 24-Nov-03
Change order No.: 1
Contractor Name: T.F.Sahli Construction,Inc.
&Address P.O. Box 332 City CAG No.: CAG-03-163
Seahurst,WA 98062 Contract For: 316.000000.020.5940.0076.63.000001
The Contract is hereby amended as follows:
1)Bid bond required(after bid date) Add $900.00
2)Reconnect sewer and water line;extend 40+feet and cap for future use. Add $500.00
Subtotal $1,400.00
Washington State Sales Tax at 8.8% $123.20
TOTAL CONSTRUCTION COST IMPACT OF THIS CHANGE ORDER........................... Add $1,523.20
The change order shall include all Contractor(s) labor, material,overhead, profit, and all direct and/or indirect costs
allocated with the Change in Scope of Work. Excluding Bond Premiums.
This Change Order is not valid unless signed by the Owner and Contractor
The original Contract Sum was ..................................................................................... $36,000.00
Net Change by previously authorized Change Order(s)was ............................................. $0.00
The Contract Sum prior to this Change Order was........................................................... $36,000.00
The Contract Sum will be revised by this Change Order in the amount of.......................... $1,523.20
The new Contract Sum incorporating this Change Order will be........................................ $37,523.20
The Contract Time will be changed by .......................................................................... N/A
The Substantial Completion Date including this Change Order is ...................................... N/A
NOTE:The above summary does not include any changes in the Contract Sum or Contract Time which have been approved
by Construction Change Directive or Field Directive forms.
OWNER CONTRACTOR
City of Renton T.F.Sahli Construction,Inc.
Community Services Dept. P.O. Box 332
1055 South Grady way Seahurst,WA 98062
Renton,Washington 98055
Date
2003-258aa
T.F. SAHLI CONSTRUCTION
P.O. Box 332
Seahurst, Washington 98062
Telephone: (206) 248-0580
STATEMENT
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DESCRIPTION AMOUNT W;" 046', —R, I -bi& 900
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Sub Total: -3 7 4/-0v a o
TERMS: Payment due on receipt of
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invoice. 1-1 1/2% per month U d � Tota+A
on all Past Due Invoices.
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