Authorization No.

Authorization of
Sheet of Contract Changes
Date:
Consultant FHWA Exempt Major Change County
In-House Non-Exempt Minor Change Section

Consultant’s Name: Route

District
Contractor: Contract No.
Address: Job No.
Project No.

The following change from the plans in the construction of the above designated section of highway improvement is authorized and directed. The
estimated quantities are shown below at the awarded contract prices except as indicated. The first addition of an item not in the original contract under the
fund type or county is indicated by an asterisk.

Item No. * Cat Pay Item Unit Quantity Unit Price Addition Deduction

Amount of original contract: Totals

Net change to date: Percent Change: Net Change

Project Location: THE STATE OF ILLINOIS

By the Department of Transportation
Description and Reason:

Determination: Timothy W. Martin, Secretary Date

By Milton R. Sees, Director of Highways

Approved Deputy Director Division of Highways Ann L. Schneider, Director of F&A Date
Regional Engineer
Ellen Schanzel-Haskins, Chief Counsel Date
Approved Engineer of Construction
Supervisor:
Resident:
Approved Director of Highways, Chief Engineer Resident

Approved for Federal Participation Advance Approval Given Considered Non-participating

Date Division Engineer Date Date Division Engineer

BC 22 (Rev. 5/06)