U.S. Department of Transportation Federal Highway Administration |
RECORD OF AUTHORIZATION TO PROCEED WITH MAJOR CONTRACT REVISION | |||||||||
PROJECT NO. | COUNTY | STATE | ||||||||
TYPE OF REVISION
| ||||||||||
REQUESTED BY | DATE | |||||||||
NATURE OF AND REASON FOR PROPOSED REVISION (If additional space is required, use reverse side) | ||||||||||
ESTIMATED
|
METHOD OF PAYMENT
|
|||||||||
THE WORK COVERED BY THE PROPOSED REVISION AS DESCRIBED ABOVE IS HEREBY AUTHORIZED SUBJECT TO THE CONDITIONS MARKED BELOW:
| ||||||||||
RECOMMENDED BY AREA ENGINEER | DIVISION OFFICE APPROVAL | |||||||||
SIGNATURE
|
DATE | SIGNATURE | DATE |
Form FHWA-1365 (Use Reverse for Comments, if Required)
(Rev. 3-86) PREVIOUS EDITIONS MAY BE USED