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[]
["CITY OF NEWTON CHANGE REQUEST FORM"]
[]
["THIS FORM WILL BECOME A CHANGE ORDER FORM AFTER ALL APPLICABLE PARTIES HAVE SIGNED AND DATED IT."]
[]
[]
["PROJECT NAME:",null,null,null,null,null,"DATE:"]
["P.O. NUMBER:",null,null,null,null,"ORIGINAL P.O. DATE:"]
["REQUESTED BY:",null,null,null,null,null,"TITLE:"]
[]
["CHANGE #1:"]
[]
[]
["INCREASE OR DECREASE TO JOB COST FOR THIS CHANGE:"]
[]
["CHANGE #2:"]
[]
[]
["INCREASE OR DECREASE TO JOB COST FOR THIS CHANGE:"]
[]
["CHANGE #3:"]
[]
[]
["INCREASE OR DECREASE TO JOB COST FOR THIS CHANGE:"]
[]
["CHANGE #4:"]
[]
[]
["INCREASE OR DECREASE TO JOB COST FOR THIS CHANGE:"]
[]
["TOTAL INCREASE OR DECREASE TO JOB FOR ALL LISTED CHANGES:"]
[]
[]
["REQUESTOR:",null,null,null,null,null,null,"DATE:"]
[]
["DEPARTMENT HEAD:",null,null,null,null,null,null,"DATE:"]
[]
["PURCHASING AGENT:",null,null,null,null,null,null,"DATE:"]
[]
["FINANCE DIRECTOR:",null,null,null,null,null,null,"DATE:"]
["This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act."]
[]
["CITY MANAGER:",null,null,null,null,null,null,"DATE:"]
["If Applicable:"]
[]
[null,"DATE ACCEPTED AS A CHANGE ORDER:"]
[]
["THIS INSTRUMENT IS INVALID IF UNSIGNED BY THE CITY FINANCE DIRECTOR."]

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["SCHEDULE OF PREVENTATIVE MAINTENANCE PROPOSAL/CONTRACT"]
[]
[null,null,"VISUAL INSPECTION",null,"FILTER REPLACEMENT",null,"BELT REPLACEMENT",null,"COIL CLEANING"]
["JANUARY",null,"X",null,"X"]
["FEBRUARY"]
["MARCH"]
["APRIL",null,"X",null,"X",null,"X",null,"X"]
["MAY"]
["JUNE "]
["JULY",null,"X",null,"X"]
["AUGUST"]
["SEPTEMBER"]
["OCTOBER",null,"X",null,"X"]
["NOVEMBER"]
["DECEMBER"]
["PLEASE NOTE THAT FILTER MEDIA, BELTS, COIL CLEANER, REFRIGERANT LEVEL CHECK, AND"]
["LUBRICANTS ARE THE ONLY MATERIAL TO BE PROVIDED UNDER THIS CONTRACT.  ANY OTHER"]
["MATERIAL AND THE ADDITIONAL LABOR TO INSTALL WILL BE PROVIDED AT ADDITIONAL COST TO"]
["THE OWNER."]
[]
["PREVENTATIVE MAINTENANCE PROGRAM BUILDING LIST"]
[]
["BUILDING",null,null,null,"PHYSICAL ADDRESS",null,"NUMBER OF UNITS",null,"PRICE"]
["Newton City Hall",null,null,null,"401 North Main Ave.",null,13]
["Newton Police Complex",null,null,null,"2427 North Ashe Ave.",null,1]
["Newton Public Works",null,null,null,"201 West 4th Street",null,3]
["Newton Waste Water Treatment Plant",null,null,null,"1407 McKay Road",null,3]
["Newton Water Plant",null,null,null,"1780 Hwy 10 West",null,1]
["Newton Fire Department Station 1",null,null,null,"116 West A Street",null,1]
["Newton Fire Department Station 2",null,null,null,"560 West 21st Street",null,1]
["Newton Fire Department Station 3",null,null,null,"4197 Startown Road",null,1]
["Newton Recreation Center",null,null,null,"23 South Brady Ave.",null,5]
["Central Recreation Center",null,null,null,"301 South Ervin Ave.",null,1]
["Southside Community Building",null,null,null,"1771 Southwest Blvd.",null,1]
[null,null,null,null,null,"TOTAL CONTRACT AMOUNT"]
[]
["FOR ANY SERVICE ABOVE AND BEYOND THIS MAINTENANCE AS SPECIFIED ABOVE, THE HOURLY RATE"]
["FOR THIS WORK SHALL BE $_____________/HOUR PLUS PARTS .  THE ABOVE RATE INCLUDES BUT NOT"]
["LIMITED TO ALL TRAVEL, TRUCK, EQUIPMENT AND ASSOCIATED EXPENSES RELATED TO A SERVICE"]
["CALL."]
[]
["THE ABOVE LISTED BUILDINGS HAVE BEEN SURVEYED AND EQUIPMENT NUMBERS, MODEL"]
["NUMBERS, AND SERIAL NUMBERS ARE GIVEN WHERE POSSIBLE IN ATTACHMENT.  THE CONTRACTOR"]
["SHALL VERIFY THE EQUIPMENT NUMBER, MODEL NUMBER, AND SERIAL NUMBER AS WELL AS ANY"]
["ADDITIONAL SERVICEABLE OVERLOOKED EQUIPMENT AND VERIFY WITH OWNER.  SEE"]
["ATTACHMENT FOR EQUIPMENT LIST BY BUILDING."]

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["PREVENTATIVE MAINTENANCE PROGRAM PROPOSAL/CONTRACT"]
[]
["THIS PROPOSAL BECOMES A  CONTRACT WHEN THIS PAGE IS COMPLETED, SIGNED AND DATED BY"]
["QUALIFIED REPRESENTATIVES OF EACH CONCERNED PART."]
[]
["THIS CONTRACT PERIOD SHALL BE FROM",null,null,null,null,"2007-07-01",null,"TO","2008-06-30"]
[]
[]
["THE RENEWAL PERIOD SHALL BE ANYTIME BEFORE THE LAST DAY OF THE LAST MONTH PRIOR TO"]
["THIS CONTRACT EXPIRES."]
[]
[]
[]
[]
[]
["THIS CONTRACT IS ACCEPTED BY:"]
[null,null,null,null,"(COMPANY)"]
[]
[]
[null,null,null,null,"(SIGNATURE)"]
[]
[]
[null,null,null,null,"(TITLE)",null,null,null,"(DATE)"]
[]
["THIS CONTRACT IS APPROVED BY:"]
[null,null,null,null,"(COMPANY)"]
[]
[]
[null,null,null,null,"(SIGNATURE)"]
[]
[]
[null,null,null,null,"(TITLE)",null,null,null,"(DATE)"]
[]
["PAYMENT SHALL BE NET THIRTY DAYS FROM DATE OF INVOICE AND SHALL BE BILLED WITHIN"]
["30 DAYS OF EACH SERVICE SCHEDULE AS FOLLOWS:"]
[]
["BILLING MONTH",null,null,null,"WRITTEN AMOUNT",null,null,null,null,"AMOUNT"]
["JANUARY BILLING:",null,"(20% of total)"]
["APRIL BILLING:",null,"(40% of total)"]
["JULY BILLING:",null,"(20% of total)"]
["OCTOBER BILLING:",null,"(20% of total)"]
[]
["TOTAL OF ABOVE:"]