K-3 - Change Order 14, Rathje Construction - Original Town Phase Two

Date: February 2, 2022 To: Ben Carhoff Project: Tiffin Original Town Urbanization Phase II Re: COR #15R Ben, I am hereby submitting the following change order request for the relocation of the light pole on the east side of the fire station, extra work on Nolan's driveway, new item price for 9" PCC Driveway at fire station. (The number used below is the difference in new item @$79.00 and the original 9" PCC item @$46.45 difference of $32.55 per SY) this also includes an additional 2" of rock under the slab for a total of 8" due to poor subgrade conditions and concrete winter costs throughout the project. <table> <tr> <th>Item</th> <th>Description</th> <th>Qty</th> <th>Unit</th> <th>Unit Price</th> <th>MU</th> <th>Unit w/ MU</th> <th>Total</th> </tr> <tr> <td>Light Pole Relocation</td> <td></td> <td>1.00</td> <td>EA</td> <td>$867.50</td> <td>10.00%</td> <td>$943.25</td> <td>$943.25</td> </tr> <tr> <td>Driveway wall install / remove</td> <td></td> <td>1.00</td> <td>EA</td> <td>$4,250.00</td> <td>0.00%</td> <td>$4,250.00</td> <td>$4,250.00</td> </tr> <tr> <td>9" Driveway PCC</td> <td></td> <td>401.00</td> <td>SY</td> <td>$32.55</td> <td>0.00%</td> <td>$32.55</td> <td>$13,052.55</td> </tr> <tr> <td>Single layer burlap (32-35) degrees</td> <td></td> <td>188.00</td> <td>SY</td> <td>$1.00</td> <td>10.00%</td> <td>$1.10</td> <td>$206.80</td> </tr> <tr> <td>Double Layer Burlap (25-31)</td> <td></td> <td>206.00</td> <td>SY</td> <td>$2.00</td> <td>10.00%</td> <td>$2.20</td> <td>$453.20</td> </tr> <tr> <td>4 layers Burlap below 25 degrees</td> <td></td> <td>483.00</td> <td>SY</td> <td>$4.00</td> <td>10.00%</td> <td>$4.40</td> <td>$2,125.20</td> </tr> <tr> <td>Hot Water Charge</td> <td></td> <td>588.00</td> <td>CY</td> <td>$6.00</td> <td>10.00%</td> <td>$6.60</td> <td>$3,880.80</td> </tr> <tr> <td colspan="7">Total</td> <td>$24,911.80</td> </tr> </table> Additional Days Requested 0 EA Total 0.0 Please call if you have any questions.