<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 0%" />
<col style="width: 8%" />
<col style="width: 24%" />
<col style="width: 12%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 9%" />
<col style="width: 8%" />
<col style="width: 1%" />
<col style="width: 12%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="7"><strong>Draft Modification No.</strong></td>
<td colspan="4"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="15"><p><u>Bid Item No.</u></p>
<p>A. Revise….Decrease….Delete…..Provide……Modify….Increase….….[Use these
words to describe work]</p>
<p>ADD $XX.XX</p>
<p>DEDUCT ($XX.XX)</p>
<p>NO COST CHANGE $0.00</p>
<p>B. Revise….Decrease….Delete…..Provide……Modify….Increase….….[Use these
words to describe work]</p>
<p>ADD $XX.XX</p>
<p>DEDUCT ($XX.XX)</p>
<p>NO COST CHANGE $0.00</p>
<p>TOTAL ADD – Bid Item No. [add A plus B] $XX.XX</p>
<p><u>New Bid Item No</u>.</p>
<p>A. Revise….Decrease….Delete…..Provide……Modify….Increase….….[Use these
words to describe work]</p>
<p>ADD $XX.XX</p>
<p>DEDUCT ($XX.XX)</p>
<p>NO COST CHANGE $0.00</p>
<p>B. Revise….Decrease….Delete…..Provide……Modify….Increase….[Use these
words to describe work]</p>
<p>ADD $XX.XX</p>
<p>DEDUCT ($XX.XX)</p>
<p>NO COST CHANGE $0.00</p>
<p>TOTAL ADD – Bid Item No. [add A plus B] $XX.XX</p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="15"><p>Except as modified above, all work shall be
performed in accordance with the provisions of the contract where
applicable as determined by the Contracting Officer or as otherwise
directed by the Contracting Officer.</p>
<p>Compensation will be made for the additional work; contract bid
schedule is modified as follows:</p></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"><p><strong>Orig.</strong></p>
<p><strong>Est. Quant.</strong></p></td>
<td><strong>Revised Est. Quant.</strong></td>
<td><strong>Item</strong></td>
<td><p><strong>Original</strong></p>
<p><strong>Unit</strong></p>
<p><strong>Price</strong></p></td>
<td colspan="3"><p><strong>Revised</strong></p>
<p><strong>Unit</strong></p>
<p><strong>Price</strong></p></td>
<td colspan="3"><strong>Original Amount</strong></td>
<td colspan="2"><strong>Amt. of Increase or (Decrease)</strong></td>
<td><strong>Revised Amount</strong></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="15"><p>* Indicates previously revised item,
Modifications(s) No(s). through .</p>
<p>** Indicates new schedule item.</p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="15">This Modification No. results in an increase of $ (or a
decrease of $ ) [or no change] in the contract amount. The revised
amount is accordingly established as follows:</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td colspan="6">Original Contract Amount</td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="6">Modification No. 1 [Increase - (Decrease) - No
Change]</td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td colspan="6">Modification No. 2 [Increase - (Decrease) - No
Change]</td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="6">Modification No. 3 [Increase - (Decrease) - No
Change]</td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td colspan="6"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="6"><strong>Revised Contract Amount</strong></td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

No additional contract time will be allowed as a result of the extra
work involved and the contract completion date remains .

An allowance of additional calendar days will be made as a result of the
additional work involved under this modification and the contract
completion date is hereby changed from to .

The foregoing Modification No. is satisfactory and is hereby accepted.
In accepting this Modification No. , the contractor acknowledges that he
has no unsatisfied claims against the Government arising out of or
resulting from this modification, and the contractor hereby releases and
discharges the Government from any and all claims or demands whatsoever
arising out of or resulting from this modification.