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DocuSign Envelope ID:75FE39C7-BC6A-40EE-BF86-44BCFC63729F <br /> EXHIBIT"C" <br /> AUTHORIZATION OF CHANGE IN SERVICE <br /> CONTRACT NAME: NUMBER: <br /> CONTRACTOR: <br /> ORIG.CONTRACT DATE: RESOLUTION NO: <br /> CITY REPRESENTATIVE: DEPT: <br /> DATE: ACIS NO.: <br /> DESCRIPTION OF WORK TO BE ADDED TO OR DELETED FROM SCOPE OF SERVICES: <br /> Original Contract Amount: $ <br /> Previous Increases/Decreases in Contact Amount: $ <br /> CURRENT CONTRACT AMOUNT: $ <br /> This Increase/Decrease in Contract Amount: $ <br /> REVISED CONTRACT AMOUNT: $ <br /> CONTRACTOR: <br /> Signature Date <br /> Print Full Name/Title(if not in individual capacity) <br /> CITY: <br /> Signature Date <br /> Print Name/Title <br /> City Department Use Only Below This Line(PM,POC,etc.). <br /> Line Year Project String Org Object Amount Column Adjustment to =Revised Notes <br /> (This is NOT the be made Amount <br /> Available Amount <br /> column) <br /> Rev 06.13.2022 Page 12 of 12 <br />