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MN/DOT TP -02134-04(2/99) <br />STATE OF MINNESOTA DEPARTMENT OF TRANSPORTATION <br />SUPPLEMENTAL AGREEMENT NO. 1 <br />• <br />Supp. To Contract No. <br />Page 1 of 1 <br />CONTRACTOR; <br />$704,053.55 <br />FEDERAL PROJECT NO. <br />t <br />STATE PROJECT NO. <br />Northwest Asphalt, Inc. <br />$715,049.45 <br />N/A <br />147-102004 <br />ADDRESS: 1451 Stagecoach RD <br />LOCATION OF WORK 14th Street NW between 29th Avenue NW and <br />Shako ee, MN 55379 <br />Silver Lake Road <br />GROUP NO. <br />I APPR. AMOUNT <br />GROUP NO, APPR, AMOUNT GROUP NO. APPP <br />AMOUNT <br />DATE ENCUMBERED <br />Dated: <br />ORIGNINAL ENCMUBRANCE: <br />SA TOTAL $ <br />BY: <br />$ ENCUMBERED TO DATE: <br />Approved as to form and execution: <br />Individual signing certifies that funds have been encumbered as <br />required by Minn. Stat. § 16A.15 <br />Dated: <br />This Contract is between the State of Minnesota, acting through its Commissioner of Transportation, and Contractor as follows: <br />NOW, THEREFORE, IT IS HEREBY MUTUALLY AGREED AND UNDERSTOOD THAT: <br />The following items are to be added to and become part of the contract: <br />ESTIMATE OF COST <br />Item No. Item Unit Unit Price Quantity Amount Group <br />2503.601 Relay Sanitary Sewer Service LS $6,560.40 1 $6,560.40 <br />W 601 Abandon Sanitary Sewer Service LS $4,435.5 1 $4,435.50 <br />al of Supplemental Agreement 1 $10,995.90 <br />All items are considered non -participating and will be paid with local funds. <br />Original Contract Amount <br />$704,053.55 <br />Supplemental Agreement 1 <br />$ 10,995.90 <br />New Contract Amount <br />$715,049.45 <br />Commissioner of Transportation: <br />Commissioner of Administration <br />7/ <br />P ect ngineer <br />Dated: IE' <br />By: <br />Pursuant to Delegation <br />By: <br />Commissioner of Administration or Pursuant to <br />i <br />Dated: <br />Delegation <br />By <br />ontractor <br />Approved as to form and execution: <br />Dated:g <br />Dated: <br />By: <br />Assistant Attorney General or Pursuant to Delegation <br />Assistant District Engineer <br />ed: <br />Dated: <br />