STATE OF MINNESOTA DEPARTMENT OF TRANSPORTATION Supp. To Contract No.
SUPPLEMENTAL AGREEMENT NO.
Page 1 of 1
CONTRACTOR; FEDERAL PROJECT NO. STATE PROJECT NO.
ADDRESS: LOCATION OF WORK
GROUP NO. APPR. AMOUNT GROUP NO. APPR. AMOUNT GROUP NO. APPR. AMOUNT
DATE ENCUMBERED ORIGNINAL ENCMUBRANCE: SA TOTAL $
BY: $ ENCUMBERED TO DATE:
Individual signing certifies that funds have been encumbered as
required by Minn. Stat. § 16A.15
This Contract is between the State of Minnesota, acting through its Commissioner of Transportation, and Contractor as follows:
NOW, THEREFORE, IT IS HEREBY MUTUALLY AGREED AND UNDERSTOOD THAT:
ESTIMATE OF COST
Item No. Item Unit Unit Price Quantity Amount Group
####.### item description unit unit price * -XX.XX -$XXX.XX ?
Subtotal for decrease
####.## Item description unit unit price XX.XX XXX.XX ?
Subtotal for increase
* Contract Unit Price
Commissioner of Transportation: Commissioner of Administration
Pursuant to Delegation By:___________________________________
Commissioner of Administration or Pursuant to
Assistant District Engineer