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Ail' . <br />EMERGENCY CHANGE ORDER <br />! <br />COLORADO DIVISION OF <br />COLORADO RECLAMATION, MINING <br />D i v I s t o N o f & SAFETY <br />RECLAMATION 1313 Sherman St. Rm. 215 <br />MINING Denver, CO 80203 2273 <br />SAFETY (303) 866 -3567 <br />Project Name.— <br />111-Q. <br />Date: 1 <br />Contractor N e- <br />Bid <br />1 – – it IC4 <br />Contractor A ress: <br />Agreement #. <br />Project Manager: Change Order#: (^ <br />Y � <br />Use this form to authorize work changed due to thanged conditions within the scope of the <br />p Agreement Emergency Change Orders resulting in increased <br />Agreement price or Completion time must be approved by a formal Change Order WITHIN 14 days. The following changes are authorized at the direction of the <br />DRMS PROJECT MANAGER. <br />Item No. <br />DESCRIPTION AND JUSTIFICATION OF CHANGES <br />$ Increase /Decrease <br />2 c , JAS C � j-� c �.. c4im <br />oci, q� u mw V c4cLt16tc 4 -dw" . <br />� � <br />. c�.IN� �,A 4 <br />� <br />}� ajcb � <br />Ar Jw 640 <br />Net Change in Agreement Price: <br />Net Change in Agreement Time: <br />This document shall become an amendment to the Agreement. All An reement provisions shall apply. <br />Approved by : / _ , DRMS Project Date: <br />Mana er <br />Accepted b y , Contractor 3 0 <br />Date: 3 )1 9 <br />As of 01/08/09 <br />