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Docusign Envelope ID:OD1 B73D8-FE9F-4145-B1 89-00576BE6FCDD <br /> EXHIBIT 4 <br /> AUTHORIZATION OF CHANGE IN SERVICE <br /> CONTRACT NAME: NUMBER: <br /> CONTRACTOR: <br /> ORIG.CONTRACT DATE: RESOLUTION NO: <br /> CITY REPRESENTATIVE: DEPT: <br /> DATE: ACTS 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 /> CtJRRENT CONTRACT AMOUNT: $ <br /> This Increase in Contract Amount: $ <br /> REVISED CONTRACT AMOUNT: <br /> CONTRACTOR: <br /> Signature Date <br /> Print Full Name/'ritle(if not in individual capacity) <br /> CITY: <br /> Signature Date <br /> ................. <br /> -Print Name 1- it-le <br /> 0140y Department Use Only Below This Line(]W,POC, etc.). <br /> Account Number(s): Amount Date <br /> 02/21/17 Rev.05,25.2021 Page I of I <br />