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A6"4MStjT E6K-WT ROUTING FORM <br />Contract <br />Amendment J <br />ndum <br />de <br />GJN <br />Assessable? Yes No <br />To: #Ifi vision Manager For: <br />ntract Administrator <br />H1(d Director <br />qty Manager <br />PW Admin. (Budget) <br />q'nit'als <br />mber /Log <br />& f'nitials Signature <br />VOW <br />✓ Sl gnature - Return to (0NAH()r4 at �� A- !N1• <br />P.O. - Return to <br />at <br />Contractor: L.AO& T(Utusrf ®1S11U G7 <br />Title: <br />Type: PS AIA GR OTHER: +�a�t. Manager: , Jot4 J C 1EL- <br />Begin date: ,Jc,j-y Ioq End date: W olin ( 1wort' iOrr. (5EF I 2, <br />Purpose of contract /agreement: �STRLDW t4WID1 FOR THE IGN <br />OF *- ft&MDw OF AmA -zoay BR:PX is LftE — InAusil 'D)sZ ur <br />are i WfA 40 . <br />ti 1: 1vt Q <br />Budget Information: 7 1qqt <br />CITY RECORDER <br />Amount: P.O. tt: <br />*CEORDR Authorization Name: <br />Account Code: <br />— OH- - 9 i �.,� - y S 7 / .S Amount: 3 Z ? 1 � <br />Account Code: <br />Account Code: <br />Amount: <br />Amount: <br />TOTAL: <br />Notes: V 1Ae, : k� I VV'VD "'W ,1LfI�h��) 1 17 2 0 r 5 0 <br />1 V1 y 3 2 ZI, 3p <br />