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STATE AID FOR LOCAL TRANSPORTATION Rev.February 2018 <br /> DANSP RTA OF CHANGE ORDER <br /> TRANSPORTATION <br /> SAP 199-115-004 MN Project No.: NA Chap <br /> � e Order No. 2 <br /> ----- <br /> --- P <br /> Project 2022 Riverdale Drive Trunk UtilityImprovements <br /> ----------- <br /> Local Agency City of Ramsey Local Project No. 22-05 _ <br /> Contractor Dou las-Kerr Underground LLC - <br /> Address/City/State/Zip 2142 330ch Avenue, Mora, MN 5551 ,.... <br /> Total Change Order Amount$ 2,800.00 <br /> During excavation activities on the 2022 Riverdale Drive Trunk Utility Improvements the residential septic tank, <br /> located at approximately STA 2+00 on Riverdale Drive, was encountered and it has collapsed. The residential <br /> home and septic tank were proposed to be demolished during the subsequent roadway project (SP 02020- <br /> 121, SAP 199-115-005) later this year. Since this now presents a health and safety risk, the septic tank will be <br /> pumped and removed under this contract. Attached is the MPCA Abandonment form for reference. <br /> Estimate Of Cost: (Include any increases or decreases in contract items,any negotiated or force account items.) <br /> Item +or—— +or <br /> 7— ,Description Unit Unit rice Quantity Amount$ <br /> CO2 - 1 REMOVE SEPTIC TANK(2104.502) LUMP SUM $2,800.00 1 $2 800.00 <br /> Net Change this Change order $2580Due to-this change, 3.0D <br /> R contract time: <br /> 1111 (X71s NOT changed ( ) May be revised as provided in MnDOT Specification 1 p p 805 <br /> Approved by Project Engineer: Date; 4/26/2022 <br /> Print Name: Kevin P. Kielb, P.E. Phone: (651) 968-7760 <br /> Approved by Contractor: -- Date: 1-7_� Lz <br /> Print Name: Phone: - S" 37 <br /> Approved by City Engineer: Date: <br /> Print Name: Phone: <br /> -: The State of Minnesota is not a participant in this contract. Signature by the <br /> District State Aid Engineer is for FUNDING PURPOSES ONLY and for compliance with State <br /> and Federal Aid Rules/Policy. Eligibility does not guarantee funds will be available. <br /> This work is eligible for; Federal Funding X State Aid Funding X Local funds <br /> Kyle Puent Digitally signed by Kyle Puent <br /> For District State Aid Engineer,. Date:2022.04.27 14:26:10-05'00' <br /> Date, <br /> Page 1 of 1 <br />