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Docusign Envelope ID: E74COCFE-CO64-4OD2-A75B-E107999569F8 <br />VXHIRIT 4 <br />AUTHORIZATION OF CHANGE IN SERVICE <br />CONTRACT NAME: <br />NUMBER: <br />CONTRACTOR: <br />ORIG. CONTRACT DATE: <br />RESOLUTION NO: <br />CITY REPRESENTATIVE: <br />DEPT: <br />DATE: <br />ACIS NO.: <br />DESCRIPTION OF WORK TO BE ADDED TO OR DELETED FROM SCOPE OF SERVICES: <br />Original Contract Amount: <br />$ <br />Previous Increases in Contract Amount: <br />$ <br />CURRENT CONTRACT AMOUNT: <br />$ <br />This Increase in Contract Amount: <br />$ <br />REVISED CONTRACT AMOUNT: <br />$ <br />CONTRACTOR: <br />Signature <br />Print Full Naive / Title (if not in individual capacity) <br />CITY: <br />Signature <br />Print Naive / Title <br />Date <br />Date <br />City Department Use Only Below This Line (PM, POC, etc.). <br />Account Number(s): <br />Amount <br />Date <br />02/21/17 Rev. 05.25.2021 Page 1 of 1 <br />Page 21 of 43 <br />