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Docusign Envelope ID: E8E40881-80BB-4490-93AF-49F96DCE956C <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 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 Naive/Title(if not in individual capacity) <br /> CITY: <br /> Signature Date <br /> Print Naive/Title <br /> City Department Use Only Below This Line(PM,POC,etc.). <br /> Account Number(s): Amount Date <br /> 02/21/17 Rev.05.25.2021 Page 1 of 1 <br />