050-21 - Stripe Rite, Inc. - Supplement / Change Order 1CITY OF PORT ORCHARD
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Authorization for Change Order No. 1
Date: June 14, 2021
Project: 2021 Thermoplastic
Contractor: Stripe Rite, Inc.
8320 SW Barney White Rd.
Application Bremerton, WA 98312
Contract / Job # C050-21
This Change Order Authorizes additional work performed for item's 1,2,3,E above and beyond the
contracted amounts. Performed work for item 5 was decreased to offset some of the additional costs.
Public Works staff and PW shop inspector have verified performed work and invoiced amounts for
approval.
Contract History
Amount Sales Tax Total Date. Appvd by —
Original Contract
$25,163.00
N/A
$25163.00
13-A r-21
mayor
Change Order 1
$2,430.40
N/A
$2,430.40
14-Jun-21
Director
Total Contract $27,593.40 $0.00 $27,593,40
I have reviewed the Change Order information above and certify that to the best of my knowledge descriptions and
costs are true and accur te.
Contractor Approval Signa&ce r Public irector/City Engineer _
Ebu\ % -"a(t {1G MARK R. DORSEY, P.E.
Printed Name & Title Printed Name
Change Orders that do not exceed 10%, with a maximum of
$50,000, of either legally authorized budget limit or contract Approved:
amount established by City Council can be approved by the Public
Works Director.
Change Orders that do not exceed 10%, with a maximum of Attest:
$100,000, of either legally authorized budget limit or contract
amount established by City Council are to be approved by the
Mayor.
Change Orders over $100,000 or exceed a total of 10% require
Council Action.
Council Approval Date .`�"�;'G" �'•�
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U;16_SlreelslF_Repair&Maintenance\PevementMaNngslThermoplastic120211ConlractlCO#1-0050-21- StripeRite.doc
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