DWQ-2024-004988

UTAH STATE REVOLVING FUNDCHECKLIST FOR CHANGE ORDER REVIEWProject Name: Millville City _Collection SystemProject No: Reviewer: Beth WondimuDate: 2/7/2024Contractor: WHITAKERConstructionChange
Order #. 5Yes/Adequate: X No/Inadequate: O Not Applicable: NA Change Order Form:Scope of WorkYesTime extensionYesRevised contract completion dateNoDollar amountYesRevised contract
priceYesChange order in triplicate with original signature of:OwnerYesEngineerYesContractorYesChange order originated by:OwnerYesEngineerN/AContractorYesOriginating requestsN/AScope
of work outlined in change order drawing/sketch of workYesJustification:NecessityYesReasonableness of work and costYesAllowabilityYesEligibilityYesJustification:NecessityYesReasonableness
of work and costYesAllowabilityYesEligibilityYesJustification:NecessityYesReasonableness of work and costYesAllowabilityYesEligibilityYesEngineers cost estimate:QuantitiesN/APricesN/ASources
of informationN/AEstimated costN/ACreditsN/AContractor's price submittal and related documentationYesQuantitiesYesPricesYesSources of informationYesEstimated costYesCredits (including
basis)YesRelated correspondenceYesMinutes/evidence of negotiationsResolution of difference in quantities and pricesN/ARevised QuantitiesN/ARevised PricesN/ARevised CostN/ACredits (including
basis)N/AEngineer's evaluation of contractor's proposals and recommendationYesCommunity's assurance of reasonableness and fairness of change order andYes
costOther (please list)FILE: SRF-Millville City, Construction, Section 4