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III I II I II I II IIII III COLORADO DIVISION OF <br />CHANGE ORDER ggg MINERALS AND GEOLOGY <br />1313 Sherman St., RM 215 <br />Denver, CO 80203-2273 <br />(303)866.3567 <br />G <br />Project name (`~ /l~S / /~ / l~ <br />ate -~- ~/ _ / c~ <br /> <br />Contractorrtame /~.,~~~~U ~ILJ, ~~ ~j!/G' <br />ll <br />..(( <br />JJ Z <br />Bidp /JN ~~y/LS dZ( <br />~S <br />Contractoraddress <br />~ <br />~ ~ l O ~~ ~ - ~ PO M <br />~ _ ~(~~ <br />/ <br />U7 4/l~ /LL /G~~ ?7 Regk i7 y~Z <br />/ <br />Y <br />Project Manager ~ _ / ~~, l~N Change Orde <br />r <br />N i/ <br />T <br />Th lowing changes are h reby made to the Pur aze Order: (InGude the w/s~Vtime djusbnent for each ange) ~J <br />~j <br />FjL/6/ ~ ~/M.qj 2/P~ D /L~'~ F 7~I (.- /~ULC FI7 NG aCO~O OJ <br />\ <br />z ~~tiL,t7 ~~ lc~ ~ ~e~=17'-ff~ ~U,~rf NGi~IC' ~ ~otJ` . ~~v /' <br />Yr7~~7/ fltG ~o l cS ~ ~o id~l~ ~iJC7U~~ S <br />o v <br />~ ~n`'1 / ~ ~ ~'(~av <br /> <br />Justificafion _ <br />~f ~ (U~d/^~G ~r~~rr{itic7 ~7~/~ ~t~'~SS~I rv/~ <br />~ c~/L ~~/~6+^-+c~-/1 <br /> <br /> <br /> <br />Change to purchase order price: <br />Original Purchase Order Price: ~ h'~/ ~ 5 a. S Z <br />Current Purchase Order Price adjusted by previous Change Orders: ~ 3 I~ X5,2 - .S Z <br />The Purchase Order Price due to this Change Order will be increas d/decreased b /G 6 icy - U U <br />/ <br />The new Purchase Order Price including this Change Order will be: '~zZ /~,~ z,5 Z <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: ~ , rj , Q <br />i" ~ ,MLRD Project Manager <br />Accepted, y: <br />,Contractor <br />Approved by: <br />MLRD Program Supervisor <br /> <br />