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~icLu ui~s~i~+iVt <br /> <br />-, J'i a .ina, man ol. ~ FM 21 ~ <br />~envar, i:U 6UNb-t21o <br />"0~) II363567 <br />I Project name -~`,,_ ~ L KIt'( <br />c: - -~ <br />~ _ Date <br />, <br />. <br />Contractor name .,.i I /~ Bid # .~ !. ,. yi __ , - _- __ <br />Contractor address -; - ~ ~ <br />i..! ! L~1\ ~~~.% PO # <br />- -~ ~ <br />- ~ ~ ~-: t C~ ~ - . Req # <br />, <br />Project Manager - .~~ -, ~.~ ~ <br />t `i ! t ~:rtc. ~ Pield Directive # ~ <br />Use this form to authorize work changes due to changed conditions wthin the scope of the Purchase Order Contract. Field <br />directives resuking in increased Contract price or Completion time must be approved by a formal Change Order within 14 days. <br />The following changes are authorized at the direction of the PROJECT MANAGER: <br />ITEM No. DESCRIPTION OF CHANGES $ Increase/Decrease <br /> <br /> F <br />(~ <br />i <br />y~C'~ <br />~Iy ~.Cr~;v C' lrC, l.. r~~ i.;~ i (C L'i~7'~ <br /> '1 <br />;- <br />~ <br />~, <br />l~!LJ=!C.: lr~ I. C~ ~~ ~~ ~ ~<-t~_~'/~"l t~ ':1~-- ~ ~ F: G I'2~ ~. <br /> ~1~DlT~ut~~L -fZ~rij ~' 4jr ~~~j t=~~•) C~-~!nr'~~lC. <br /> <br />~'L"l~ <br />II'L// <br />\l~t`il <br />( <br />l~"ty\ ~: •~1 <br />li~~ <br />LtiVV L~ ,V\t 1r!lt: <br />~: <br />~ 1"~` <br />\`` ~~ ~L <br /> / <br />/ <br />T <br />'~( <br />y <br />t <br />~ <br />~ <br />l,V!\7 (_~. t +1..~7 i \/G'tl~ ~`J~ iN 1~-~~ \:l``-~ ~~J ~!r <br /> <br /> <br /> <br />Net change in Contract price <br />~ ` Net change in Contract time <br />$ ; <br />- Days <br />This document shall become an amendment to the Contract. Ail Contract provisions shall apply. <br />Approved by,/' <br />_~ ,~ <br />~l ~ Date: <br />~. <br />~ <br />- <br />_ <br />- <br />' ,Project Manager , <br />i <br />~~`t ' (~ t % %~' <br />Accepted by: ~ ~/ / / .~ ~.~ Date: I <br /> <br />~ VngionabPro(ect Manager Copy-Contractor <br />