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i <br /> 1 STATE AID FOR LOCAL TRANSPORTATION <br /> Rev.February 2018 <br /> RrN*P:RTAT( CHANGE ORDER <br /> rR►�NxPoT�r�vti <br /> SAP )91 5-004J.MN Prd'ect No.: NA <br /> Change order No. <br /> Project2022 Riverdale Drive Trunk Utility Improvements <br /> Local Agency Cit of Ramsey <br /> - _ Y Local Pro'ect No. 22.05 <br /> Contractor_ v Douglas Kerr Underground LL - <br /> g C <br /> Address/City/St 42 33oth Avenue, o _— <br /> Mora, MN 55051 <br /> Total.Change order Amount$ 21800,00 <br /> During excavation activities on the 2022 Riverdale Drive Trunk Utility Irn rovernents the residential 'Y P ential septic tank, <br /> located at approximately STA 2+00 on Riverdale Drive,was encountered and it has coll <br /> apsed,The residential <br /> home and,septic tank were proposed to be demolished during the subsequent roadway project SP 02020- <br /> 1211 p 1 � <br /> SAP'199- -005}later this year. S1nce this now presents a health and safety risk, the se tic tank will be <br /> um ed p <br /> p p and removed under this contract.Attached is the MPCA Abandonment form for reference. <br /> i <br /> � 1 <br /> item t <br /> . +or—MEMO <br /> +or- <br /> Description Unit Unit Pace <br /> No. Quantify Amount$ <br /> CO2- 1. REMOVE SEPTIC TANK(2104.502) LUMP SUM $2,800.00 � 2 800.00 !. <br /> $ , <br /> Net.Chan a this Chan a order, <br /> 9 9 $29800.00 <br /> Ail:111111111i <br /> �X } s NOT changed } May be revised as rovided in MnD p OT Specification 1 806 <br /> � s <br /> Approved by Project Engineer: 't Date-, 4/25/2022 <br /> Print Name: Kevin P. Kielb, P.E. : 65'1 968�-7760 <br /> Phone, � } � <br /> Approved by Contractor: <br /> Date. .-1-73-t� <br /> Print Name: =s <br /> �����, �� 1n: Phone. z� 7 - � <br /> Approved y City Engineer; a� Date: <br /> print Name: <br /> LPhone; 4-3 <br /> _} <br /> DSE Portion: The State of Mnnesta is not a partici ant in this oontraet. Si na u ,p g t re by the <br /> District State.Aid Engineer is for FUNDING PURPOSES ONLY and for.Gotxtpltance 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 Fundin X Loca <br /> l al funds ; <br /> itally signed by Kyle Puent <br /> . Ie Puent/,.,,"'-."g.For District State Aid Engineer. yDate:2022,U4.274:26;�0-o�'Oo' <br /> Date, <br /> Page I of 1 <br />