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COLORADO MINED LAND <br /> CHANGE ORDER RECLAMATION DIVISION <br /> 1313 Sherman St.,RM 215 <br /> Denver,CO 80203-2273 <br /> (303)866-3567 <br /> Project name U J h y Date 1 5 <br /> Contractor name L _ G� <br /> 7) - N <br /> Contractor address PO# C., _ 6479 <br /> Project Manager Change Order#/ <br /> aU ! cab ev- <br /> The following changes are hereby made to the Purchase Order:(Include the cost/time adjustment for each change) <br /> /zr i r C- G i �275G1•t <br /> �; �( <br /> 1 GQC fCk.0 ? baC lC Il c� 5(.G� f''tC e <br /> 14 Ic ` f t;k/ jr a oci �- <br /> Justification <br /> 133 Ja <br /> Change to purchase order price. <br /> Original Purchase Order Price: <br /> Current Purchase Order Price adjusted by previous Change Orders: aC. OL' <br /> The Purchase Order Price due to this Change Order will increase / by: (p 3 S cv <br /> The new Purchase Order Price including this Change Order will be: i j 5 3 S o° <br /> Change to purchase order time: <br /> The Purchase Order time will be increased/decreased by: n Q <br /> The date for completion of all work will be: <br /> Recommended by: <br /> 'I /I�t - l/LT , , MLRD Project Manager <br /> Accepted by: <br /> '—i�rC ��� ) /,,�/ CLt:L 5�3� , Contractor <br /> Approved by: <br /> MLRD Program Supervisor <br /> 2 <br />