K-2 - Change Order 1 - Boomerang - Potter Creek Interceptor Sewer

REQUEST FOR CHANGE Project No: 23014 Contact Name: Ben Carhoff Project Name: Tiffin Potter Creek Sewer Reason/Comments: Connect 6" service to new main and abandon and plug remainder of existing service. <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>Sanitary Sewer Service Connection</td> <td>1.00</td> <td>LS</td> <td>2,200.00</td> <td>$2,200.00</td> </tr> </table> TOTAL FOR REQUEST FOR CHANGE $2,200.00 ADDITIONAL WORKING DAYS - Owner Representative Name (print) Signature Date Keegan Parizek Keegan Parizek 11/27/2023 Boomerang (print name) Signature Date