l WASHINGTON STATE

DEPARTMENT OF TRANSPORTATION

CHANGE ORDER DATE: 01/17 /17 Page 1 of .3

CONTRACT NO: 008128 FEDERAL AID NO: CONTRACT TITLE: SR 522, SN'JliCMISH RIVER BRIOOE 'IO US 2 VIC � CHANGE ORDER NO: 188 RESOLVE ALL ISSUES

f'1 CC PRIME CONTRACTOR: sCARSELIA BROS., me. f= / V CD

P o oox 68697 JAN 2 0 2017 WA sex;�-0697

SELLA BRos, /Ne. SE'ATI'LE

(X) Ordered by Engineer under the terms of Section 1-04.4 of the Standard Specifications

SURETY CONSENT:

I ATTORNEY IN FACT

DATE

ORIGINAL CONTRACT AMOUNT: CURRENT CONTRACT AMOUNT: ESTIMATED NET CHANGE THIS ORDER: ESTIMATED CONTRACT TOTAL AFTER CHANGE: Approval Required: ( ) Region

DATE

73,138,890.32 75,334,803.81

2,042,000.00 77,376,803.81

( ) Olympia Service Center

�) APPROVAL RECOMMENDED ( ) EXECUTED EXECUTED:

� 77 � Tim Nau,Asst. PE

PROJECT ENGINEER

( ) Local Agency

j.A"APPROVAL RECOMMENDED ( ) EXECUTED OTHER APPROVAL WHEN REQUIRED

RmmN�AD�rk6 tLIL

DATE

CG02v04 lrevlsed Feb 2005) rb, nG. ,� "7Jq

SIGNATURE

REPRESENTING

DATE