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DocuSign Envelope ID:CE5FC79A-2819-445F-B9EC-5BF4EOA07FD6 <br /> EXHIBIT" 3 " <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 /> t` �' (� �•� X02 <br /> S' nature Date <br /> IVY, <br /> f) <br /> i � <br /> Print Na e/Titre" <br /> Qty De artmeut Use Only Belmv This Line PM,POC,etc. . <br /> Account Number (s): Amount Date <br /> 02/21/17 Rev. 05.25.2021 Page 1 of 1 <br />