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COLORADO DIVISION OF <br /> MINERALS AND GEOLOGY <br /> EMERGENCY CHANGE ORDER 1313 Sherman St. Rm.215 <br /> Denver, CO 80203 2273 <br /> 303 866-3567 <br /> Project Name CU>a-/ 7,r;iti / p �lv S Date <br /> y-� <br /> Contractor Name Bid# <br /> Contractor Address Agreement# <br /> `i' <br /> Project Manager Change Order#IL <br /> 3 <br /> Use this form to authorize work changes due to changed conditions within the scope of the Agreement. Emergency Change <br /> Orders resulting in increased Agreement price or Completion time must be approved by a formal Change Order within 14 days. <br /> The followinc chan es are authorized at the direction of the PROJECT MANAGER: <br /> ITEM No. DESCRIPTION OF CHANGES $ Increased <br /> ( G 7 v 4 t �'�a J e c. T A&/ti! fi-e-z 15 A S <br /> 3 /+1t2 - Z. S" <br /> roj4tL ,'9iha AC/Q-4i—e _ /¢.0 ls►C <br /> �- A d r o c t c R c /i c•1 G e / 5 rn i F <br /> �'[rt S'/uCi 7r,.-f <br /> ✓�� /= S , r c 4 f5 A e e1 t1 L. e rz) a r Z 1: <br /> r .•7/►z Jr 4 a r1 /3 e Av- A c- <br /> 7✓rc I}C/Le a ve 1i S C••tn i F-J d— iZi" ��� = r T� i s 14.r A c, <br /> A-„, i—C/U 4 5,e v/— !� . y® /* r n /3 "D <br /> 5 e 4-n F 7 S I, L¢ //� = s `I`1 �,� C-� s �`'�14 4- = <br /> t o�� <br /> Net change in Agreement price$ Net change in Agreement time ^ DAYS <br /> This document shall become an amandment to the Agreement. All Agreement provisions shall apply. <br /> Approved by: Date: <br /> Project Manager /V <br /> Accepted by: Date: <br /> Contractor <br /> Original:Project Manager Copy:Contractor <br /> Revised 7/02 <br />