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Grant Recipient: <br />JUSTIFICATION FOR CHANGE TxCDBG Contract No.: <br />Change Order No. <br />1. Will this Change Order increase or decrease <br />the number of beneficiaries? 0 Increase ❑ Decrease O No Change <br />If there is a change, how many beneficiaries will be affected? Total UM <br />2. Effect of this change on scope of work: <br />3. Effect on operation and maintenance costs: <br />❑ Increase O Decrease ❑ No Change <br />❑ Increase ❑ Decrease 0 No Change <br />4. Are al{ prices in the change order dependent upon unit prices <br />found in the original bid? ❑ Yes ❑ No <br />If "1SIo°, explain: <br />5. Will this change be completed within the contract period? ❑ Yes ❑ No <br />If "No", expected comptefion date: <br />(completion date) <br />6. Has this change created new circumstances or environmental <br />conditions which may affect the projecYs impact, such as <br />concealed or unexpected conditions discovered during actual <br />construction? O Yes ❑ No <br />If "Yes", is an Environmental Re-assessment required? ❑ Yes ❑ No <br />7. Is the Texas Commission on Environmental Quality (TCEQ) <br />clearance still valid? 0 Yes ❑ No <br />8. Is the TCEQ permit approval still valid? (sewer projects only) ❑ Yes ❑ No <br />9. Are the handicapped access requirements/approval <br />still valid (if applicable)? ❑ Yes ❑ No <br />10. Are other TxCDBG contractual special condition clearance <br />still valid? ❑ Yes ❑ No <br />(If no, specify): <br />Notice: ' Generally, a cumulative change in the contract price in excess of 25°k cannot be approved. <br />* Generally, items not included or identifying unit costs in the original bid documents cannot be <br />approved as change order items. <br />52 <br />