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

Project No: 23014 Contact Name: Ben Carhoff Project Name: Tiffin Potter Creek Sewer Reason/Comments: Replacement backfill material for fill sand to be used along Croell Ave sewer trench. Quantity in this proposal is just an estimate. Final quantity to be tracked by delivery tickets. <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>Fill Sand Backfill Material</td> <td>540.00</td> <td>TONS</td> <td>12.87</td> <td>$6,949.80</td> </tr> </table> TOTAL FOR REQUEST FOR CHANGE $6,949.80 ADDITIONAL WORKING DAYS - Owner Representative Name (print) Signature Date Keegan Parizek Keegan Parizek 11/28/2023 Boomerang (print name) Signature Date