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MG STATE AID FOR LOCAL TRANSPORTATION Rev.February 2018 <br /> O[►AJ►TJdiMT OF CHANGE ORDER <br /> TO�NSQi1ftON <br /> SAP 199-115-004 1 MN Project No.: I NA Change Order No. 3 <br /> Project 2022 Riverdale Drive Trunk Utility Improvements <br /> 1----------------- . <br /> Local Agency i Cityof Ramsey Local Project No. 22-05 AA <br /> Y ) <br /> LContractor Douglas-Kerr Underground LLC <br /> Address/City/State/Zip 2142 330t"Avenue Mora MN 55051 <br /> Total Change Order Amount$ 9,800.00 <br /> The residential home within the project area, located at STA 2+00, was demolished by the city via a controlled <br /> burn. Only the foundation material and burn debris remain. A location map along with the completed asbestos <br /> analysis is attached for reference. This change order includes the removal of foundation debris, backfilling the <br /> excavation, and compaction. <br /> Estimate Of Cost: (Include any increases or decreases in contract items,any negotiated or force account items.) <br /> Item +or— + or— <br /> Description Unit Unit Price <br /> No. Quantity Amount$ <br /> CO3-.1 12103.501 —BUILDING REMOVAL LUMP SUM 1 $9,800.00 1 $9,800.00 <br /> Net Change this Change Order $9,800.00 <br /> Due to this change, the (check _ <br /> (X ) Is NOT changed ( ) May be revised as provided in MnDOT Specification 1806 <br /> Approved by Project Engineer. de Date: 7/20/2022 <br /> Print Name: Kevin P. Kielb, P.E. Phone: 651-968-7760 <br /> Approved by Contractor: Date: ';�12 1�2 z <br /> Print Name: Phone: <br /> cV <br /> Approved by City Engineer: Date: <br /> Print Name: Phone: <br /> DSAE Portion: 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 State Aid Funding Local funds <br /> District State Aid Engineer. Date: <br /> Page 1 of 1 <br />