K-3 - Change Order 1 - Shawver Well Company - Well 5 Improvements

February 24, 2022 CHANGE ORDER NO. 1 WELL 5 IMPROVEMENTS TIFFIN, IOWA Change Order No. 1 is for the following modifications to the project: 1. Delete Bid Item 1.1.4 Drill Hole 12.25 80 LF @ $85/LF $(6,800.00) 2. Delete Bid Item 2.1.4 Drill Hole 12.25 80 LF @ $85/LF $(6,800.00) 3. Additional labor, equipment and materials to drill 14.75" hole for Test Well 5A. 80 LF @ $102/LF $ 8160.00 3. Additional labor, equipment and materials to drill 14.75" hole for Test Well 5B. 80 LF @ $102/LF $ 8160.00 Total: $ 2,720.00 Change Order No. 1 increases the contract amount by $ 2,720.00 . SHAWVER WELL COMPANY, INC. CITY OF TIFFIN, IOWA By By Title Title Date Date VEENSTRA & KIMM, INC. ATTEST: By By Title Project Engineer Title Date February 24, 2022 Date V&K Job No. 5093