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Contacting Unit: Borough of Milford

Year Ending:

The following is a complete list of all change orders which caused the originally awarded contract price to be exceeded by more than 20 percent. For

regulatory details please consult N.J.A.C. 5:30-11.1 et. seq. Please identify each change order by name of project.

1.

2.

3.

4.

For each change order listed above, submit with introduced budget a copy of the governing body resolution authorizing the change order and an

Affidavit of Publication for the newspaper notice required by N.J.A.C. 5:30-11.9(d). (Affidavit must include a copy of the newspaper notice.)

If you have not had a change order exceeding the 20 percent threshold for the year indicated above please check here

X and certify below.

, 2012

Annual List of Change Orders Approved

Pursuant to N.J.A.C. 5:30-11

Sheet 44

December 31, 2011

Clerk of the Governing Body

Date