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ST0402-CS150209Texas Department of Transportation° DALLAS COUNTY OFFICE * 4777 E. HWY 80 * MESQUITE, TX 75243 * (214)319-6502 January 7, 2015 Michael Garza, P.E. Assistant Director of Engineering Engineering Department 255 Parkway Boulevard Post Office Box 9478 Coppell, Texas 75019-9478 Control: 2374-07-058 Project: CC 2374-7-58 Highway: 1H 635 County: Dallas Dear Mr. Garza, Please find enclosed the third party funding notification sheet for Change order 4 on the above referenced project. Please return a signed copy via email to Nohemi.Parra@txdot.gov. If you have any questions, please contact me at 214-320-6241 or Elliott Stovall at 214-319-6515. $inc ely, Noel Paramanantham, P.E. Dallas Area Engineer CC: Job Files OUR GOALS MAINTAIN A SAFE SYSTEM - ADDRESS CONGESTION - CONNECT TEXAS COMMUNITIES - BEST IN CLASS STATE AGENCY An Equal Opportunity Employer TEXAS DEPARTMENT OF TRANSPORTATION CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 4 Third Party Funding Notification sheet This form Is used when the subject change order Involves funding by a source other than TxDOTN.S. DOT, and Involves third parties who are providing funding under an Advance Funding Agreement or Donation Agreement 1. Outside funding provided by: CITY OF COPPELL (Outside Entity's Legal Name) 2. Type of outside funding agreement for this change: r Existing I— Amended r New [ Check one ] 3. Indicate the type and amount of funding: Fixed Price (Lump Sum) (Estimated Amount ) Actual Cost CCSJ: 2374-07-058 Project: CC 2374-7-58 Highway: IH 635 County: Dallas District: Dallas Contract Number: 06143210 $9,375.00 Use as needed: I hereby acknowledge noftabon of the modifications (b) E&C (a) x 17.000% _ $233.75 covered by this Change Order, enter % (c) Indirect Cost": (a + b) x = $0.00 OZ V I / enter % Date l/ TOTAL $1,608.75 By Typed/Print ame 0611 EIVUL1 p5 Typed/PrintedTitle ftry MAMALrZ Funding for this Change Order has been arranged: TxDOT Representative Date Typed/Printed Name: Tx00T Form 2148-AFA- Dallas District Specific (Rev. 08/2007) A 3 &/ / / m v w o 0 0 w k 0� 0 $ E a a 0 m> 2 2 R \ & & � m 0 o \ \ \ K .. \§ d 2 g q m 0 0 0 E 2 § \ { \ c0 :71 \ \ \ 0 \ \ ƒ $ $ $ 0 < 7$ 7 § 7 7 S§ U / / \ m 2 j$ j m§ 0 w\\ ƒ A A § § § R \) / ? m -!4 k CL a cL k /§\ m m \ T. 0 M X ® 2 k \ D m / \ § § \ z z CL CL c \ \ & 0 E E § $ / / ® § « CD f :3 a \ $ / k § / _> a 0 $ a & & > z / m m m k \ / E■ 2§ z 0 ca 0 >> Ck§§ k k) \ § \ z q - m n M X .. K S m E a CO) a $ A CO) 0 / } CLT 0 z / 2 E [ § A \ m G m S o>\ I � m ° » \ A = m \ m ƒ q / m , \ \ / F- o ® < EF / \ \ 0 z E 2 ® w m § ¥ G CO) T i ¥ % m § 3 0 z § -- 2 2 0 w E $ n ® S a/z \ § ] / { $ f 0 m ( { k / � 3 :3 ❑LI❑❑ 2 9 2 ° g E \k± E CL f q_ S §k� \ 0 x D z Q m 0 � O m ;u z � � A X 0 � \ m k � 2 � B D X D m z G) z m m N CO) 4 T m v z m v r m v m T c x m 0 C m v 55 m 1 O i0 4 v m v v 22 z m v z D m v M m 1 O p 0 O z M c 1 0 z v_ C N O Z v X 4 m z O z m m A x m n O z O X v (D Co v 3- w (D(D . a CL o o m CD a, a o CD O o m v a m :3r� . 0) w' v O 9 w m 'm N 0 c o o � s <. N w 2� 2) w m Q• w w O. O m N 3 0 V1 -� w w (fl O. fD O' fD 3 O fD 7 w O rn O -3p CL w �• v w o 0 Z3 oCL c aw � o O w CD Z3 _ .< 3 w CL C o 0 r. =r 3 (D (D � OCD X o CD w co co (D w X w O O CD a o ° U) m U) O s =r o w c :3 n.(a CD Q w CD o 0 o ,. m 3 CX (D =. k § m k § ■ ) -1 _ j § j / k k \ \ m E § s m X ic Q) 2 n o m g( 2■ §a w w ( \ \ CD J a % k k �� 0 / km w --4 ^ z / \ 00 / / H / « 5 m 3 ;u $ c k � § § § § n @ a § m § § 2 k k X § X o # 0 § % \ j § § \ § j \© m ) ■ (13 § k / j2 § # ET n 0 c 3 .r.9 d to O O