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m 0 STATE AID FOR LOCAL TRANSPORTATION <br />RAPMOOfN CHANGE ORDER <br />SP/SAP(s) <br />Contractor: <br />Print Name: <br />SAP 199-101-013; <br />199-128-001 <br />MN Project No.: <br />Zcs ,g/,�z--, <br />Rev. December 2024 <br />Change Order No. <br />Date: <br />Phone: <br />1 <br />7,A6 <br />Other required signatures (MnDOT if work on Trunk Highway, other agency as needed). These signatures should be <br />inplace before submittal to the DSAE. <br />Signature: <br />Print Name: <br />Title and Agency: <br />Date: <br />Phone: <br />DSAE Portion: The State of Minnesota is not a participant in this contract. Signature by the District State Aid <br />Engineer is for FUNDING PURPOSES ONLY and for compliance with State and Federal Aid Rules/Policy. <br />Eligibility does not guarantee funds will be available. <br />This work is eligible for: Federal Funding State Aid Funding Local Funds <br />District State Aid Engineer: Date: <br />Page2of2 <br />