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II he nature and reason for the chan e Chan e of as halt mix used on ro'ect. <br /> State fu y t g g p p 1 <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 /> � The undersigned has determined that this change is in the best interest of the local agency and is authorized by <br /> law. <br /> Signed Signed ir��� S%'[;a.�G� <br /> Highway Commissioner Municipal O�cer <br /> f � <br /> � Ci� C� ltt�+' <br /> � Title of unicipal Officer <br /> December 15, 2004 <br /> Date Date <br /> Approved Recommended Approved <br /> County Engineer istrict ngineer <br /> �z�2�J�� <br /> Date �ate <br /> Note Make out separate fonn for change in length quantities. <br /> Give net quantities only. <br /> Submit 3 copies of this form to District Engineer(4 copies for road district). <br /> If plans are required attach 3 sets: <br /> BLR 6301 (Rev.2/01) <br /> Page 2 of 2 <br />