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COLORADO DIVISION OF <br /> MINERALS AND GEOLOGY <br /> EMERGENCY CHANGE ORDER 1313 Shermain St. Rm. 215 <br /> Denver,CO 80203 2273 <br /> 303 866-3567 <br /> Project Name Date <br /> Contractor Name Bid# <br /> T 7 e 0" 4 O <br /> Contractor Address Agreement# <br /> 7 <br /> Project Manager �, Change Omer# 1 <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 followin chan es are authorized at the direction of the PROJECT MANAGER: <br /> ITEM No. DESCRIPTION OF CHANGES $ <br /> A -4d, TC� n.i1Z /�-ir Xeo r <br /> S <br /> f Tr <br /> S�e c t S 77Z e eS s ¢ S r •7, <br /> y 7p_"574f� W /ltlw cvi1 77(tf ! AO_, ,t, -S(7 <br /> P ft C 4�se-0) r7 .n-c 3 D I- (n 4e a-e- z� <br /> 3 C� ST7t�c 7 Se 19v-1t-, 771 4 r i C 0 s CO. <br /> f ' l 13 <br /> r e.-7 v c r. i n.4 c i. <br /> /mod Cc-5'r CG, C- tv c 'T <br /> Net chan22 in Agreement price$ Net change in A reement time DAYS <br /> This document shall become an amend to the Agreement. All Agreement provisions shall apply. <br /> Approved by: Date- . <br /> Project Manager <br /> Accepted by: Date: <br /> Contractor o — ^D <br /> Original:Project Manager Copy:Contractor <br /> Revised 7/02 <br />