K-3 - Change Order 4 - Rathje - Original Town Phase Two

Date: August 11, 2021 To: Ben Carhoff Project: Tiffin Original Town Urbanization Phase II Re: COR #5R Rathje # 7187 Ben, I am hereby submitting the following change order request for the necessary effort to explore the water main layout in the 2nd Street and Main Street. This excavation was required to determine which lines of the distribution system was in operation. Incorrect Record Drawings from previous work and needed to investigate how the water system operated. <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>Exploratory Excavation</td> <td></td> <td>1.00</td> <td>LS</td> <td>$5,283.08</td> <td>0.00%</td> <td>$5,283.08</td> <td>$5,283.08</td> </tr> <tr> <td colspan="7">Total</td> <td>$5,283.08</td> </tr> </table> Additional Day(s): 1.0 Please call if you have any questions. Respectfully, J. Shawn Lueth, PE