K-4 - Change Order 9 - Rathje Construction, Original Town Phase Two

Date: November 5, 2021 To: Ben Carhoff Project: Tiffin Original Town Urbanization Phase II Re: COR #10 Rathje # 7187 Ben, I am hereby submitting the following change order request for installation of 2 roof drain connections for 200 Main St and installation of 1 sump pump connection for 110 2nd St. Both were connected to the 4" subdrain installed at the back of curb of Main St. This includes equipment, time and material. <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></td> <td>Installation of Downspout - 200 Main St</td> <td>2.00</td> <td>EA</td> <td>$475.00</td> <td>0.00%</td> <td>$475.00</td> <td>$950.00</td> </tr> <tr> <td></td> <td>Installation of Sump Line - 110 2nd St</td> <td>1.00</td> <td>EA</td> <td>$475.00</td> <td>0.00%</td> <td>$475.00</td> <td>$475.00</td> </tr> <tr> <td colspan="6">Total</td> <td colspan="2">$1,425.00</td> </tr> <tr> <td colspan="2">Additional Days Requested</td> <td>0</td> <td>EA</td> <td colspan="3">Total</td> <td>0.0</td> </tr> </table> Please call if you have any questions. Respectfully, Dan Scofield