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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 in Contract Amount: <br /> CURRENT CONTRACT AMOUNT: <br /> This Increase 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 /> Account Numbers : Amount Date <br /> 02/21/17 Rev.05.25.2021 Page 1 of 1 <br />