K-2 - Change Order 3 - Boomerang - Potter Creek Sewer Interceptor

Project No: 23014 Contact Name: Ben Carhoff Project Name: Tiffin Potter Creek Sewer Reason/Comments: Boomerang is providing a $3,000 deduct to the contract for repairs required along Brown St. During construction the nearby sealcoat road was damaged from construction operations. This deduct is for the City to allocate money to future seal coat programs in the city. <table> <tr> <th>ITEM NO.</th> <th>ITEM DESCRIPTION</th> <th>QTY</th> <th>UNIT OF MEASURE</th> <th>UNIT PRICE</th> <th>EXTENDED PRICE</th> </tr> <tr> <td>New</td> <td>Seal Coat Repairs</td> <td>1.00</td> <td>LS</td> <td>(3,000.00)</td> <td>($3,000.00)</td> </tr> </table> TOTAL FOR REQUEST FOR CHANGE ($3,000.00) ADDITIONAL WORKING DAYS Owner Representative Name (print) Signature Date Keegan Parizek Keegan Parizek 6/18/2024 Boomerang (print name) Signature Date