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<br />CHANGE ORDER <br />MINED LAND RECLAMATION DIVISION <br />INACTIVE MINE RECLAMATION PROGRAM <br />Purchase Order Number: c - s y;~ y ~ Purchase Requisition Number: r~~-,,: _, . ~,°! s <br />Change Order Number: z Date: a-,s- rz <br />Name of Project: ~ c_u.• ~'_ ,.~:,. ;<;~. ~ Fir <br />Contractor: ~cc= <;..,~ ~ ,~ ~=C'~.6-tiryTia ia.< <br />The following changes are hereby made to the Purchase Order:~J ~-~g~~.~.,~.,~.;_ <br />-~ <br />~Y> F.G:' ~:n,y t!F/s.c.,G~~= ~•~/5 .s •i /efV'i/i.(.-.~ PY /.'C[J. f/.O..c%~fFY /ACC-<'~ <br />Z/ '`'i`t-K<<G~ y'r oq.u> l l~ /b..i .~-._'s-.<-t 7~~.~ /.<n~_.~ ~rrv .~vcc- ~c <br />~C/'rH J/ ,O/i'c. S4 c TP ..uc-- f'~°.< ic..u ~~ Ta' ~J.«~a <br />UAL, ~[-i.ciE-- .'< :3°c~~ oa <br />Justification:(,] arcs-~~,c- C~.~=2.-~ F=.~ys .y,tE .,r-EC--~s-¢~r To <br />~ esEr.<.f.ti T r , /z,. ~.~.~ <br />7h' ~ ~.c, <-•C;- i S- Y L "i ~°~` D, ti e~- fz~ TiY~ ~ c ~.-c e= ~ a'-~-.r~: E.~~ <br />~Kicc kGY. .~ Lu4S GCC,a-f~> i[-'E /t,2 Gc.cJc.i<sE .iloc<.er Jcf i'cO i"~s <br />Ati ~'ciEi> ~'? ice.-C,e-•c-•~ NA_-+sz D ~Ta v.<,.., .a.~S . <br />Change to purchase order price: <br />.v <br />Original Purchase Order Price: ~ ~ i 9 coo <br />Current Purchase Order Price adjusted by previous Change Orders: ~ %, 9co <br />The Purchase Order Price due to this Change Order ~ <br />will be increased/decreased by: / 3 ~O '"~ <br />The new Purchase Order Price including <br />this Change Order will be: %~~z~t'• °° <br />Change to Purchase Order time: <br />The Purchase Order time will be increased/decreased by <br />The date for completion of all work will be ~/,o,- ~;, , ~ , i q 9~ <br />Recommended by_ ~~~/,~ ~/-.'~~ ~~~ ML RD Project Engineer <br />Accepted'6y: J Contractor <br />Approved by: MLRD Program Supervisor <br />