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Buyer,
Please issue a change order as detailed below to: (Vendor name on PO)
Description of Change:
For the following, fill in ONLY the information changed since the last
Purchase Order action:
Subcontract Budget Period:
Subcontract Project Period:
Increase/Decrease in Budget Period Amount by: $
Index number:
(If split index, itemize by Index # and dollar or percentage allocated)
(If change in Index #, indicate prior and new Index numbers)
Subcontractor Cost share? Y/N.
If yes, increase/decrease amount by: $
Comments:
(Anything that would aid in communicating the purpose of the change or other
meaningful information)
Backup Information:
The following backup information was/will be sent to buyer:
___ Prime Award Notice covering the Budget Period of the request
___ Subcontractor Statement of Work (Not needed if no change but
state so in Comments above)
___ Subcontractor's Detailed Budget itemizing costs allocated for the
requested Budget Period
(Not needed if grant is under
NIH SNAP)
By: (Indicate one)
___ Faxed to 534-5803; or
___ Mailed to 0914.
Certification of Authority to Place Order
I am authorized by the PI ________________ to make changes to the subject
Purchase Order. I and confirm the above information to be correct.
Dept Point of Contact: (Include name, phone, fax, and campus mail code.
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