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DocuSign Envelope ID: D776FCD3-A986-470D-9E2B-8853B19D52DF <br /> CHANGE PROPOSAL FORM <br /> Project: Efland SS to Mebane to Mebane Phase 2 <br /> Contract: 16.01904 <br /> Contractor: JF Wilkerson Contracting Inc. <br /> Utility <br /> Construction Proposal# 17 <br /> Project# CIP 30044 <br /> Contractor# C077 <br /> Description of Change: <br /> Extend driveway flumes to ditch at 311 Mt.Willing Road <br /> Driveway Flumes 1 L.S. $ 2,207.97 $ 2,207.97 <br /> Total $ 2,207.97 <br /> Time Extension Request 20 days <br /> The Contractor agrees to perform the work outlined in this change proposal for the amount specified above and in accordance with the <br /> Contract documents if the work 1f1312A899D'384C2 <br /> Dl,ocuSigneddy <br /> Contractor's Signature: 2 [� ����b1A' Docusigned by: Date: 4/15/2019 <br /> . gyp, J 4/15/2019 <br /> Approval Recommended by Design Consultant: �C�Jply[� _ D s d by Date: <br /> 8CABB174ESD04DC i U�L1 4/16/2019 <br /> Owner's Representative Approval: l,}' -�7 Ll Date: <br /> a�nn•nra�r.=n-�� <br />