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��Amount of adjusted/final contract $ 144,257.78 { I�' <br /> ❑ addition , <br /> Total net X,deduction to date $ 6,258.14 which is 5.19 % of Contract Price ' <br /> State fully the nature and reason for the change <br /> When the net increase or decrease in the cost of the contract is$10,000 or more or the time of completion is increased or <br /> decreased by 30 days or more, one of the following statements shall be checked. <br /> ❑ The undersigned has determined that the circumstances which necessitate this change were not reasonably <br /> foreseeable at the time the contract was signed. <br /> [� The undersigned has determined that the change is germane to the original contract as signed. <br /> I <br /> ❑ The undersigned has determined that this change is in the best interest of the local agency and is authorized by law. <br /> Signed Signed ��-r--� �s���� <br /> Highway Commissioner Municipal Officer <br /> c� <br /> C< y (r���r <br /> itle of M�pal Officer <br /> �' - 22—v $ <br /> Date Date <br /> Approved Recommended Approved { � <br /> <� <br /> County Engineer Regional Engineer <br /> � 3��� <br /> Date Date <br /> Note Make out separate form for change in length quantities. <br /> Give net quantities only. <br /> Submit 3 copies of this form to Regional Engineer(4 copies for road district). <br /> If plans are required attach 3 sets. <br /> Page 2 of 2 BLR 13210(Rev.7/05) <br /> Printed 5/21/2008 3:45:53 PM <br />