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<br /> ^ ~ <br /> CONTRACT MODIFICATION FORM <br /> STATE OF HAWAII <br /> DEPARTMENT OF HEALTH <br /> MODIFICATION ORDER NO. 4 Date March 22, 2004 <br /> ContractorlProvider County of Hawaii ASO LOG No. 02-119 <br /> ContractTltle Used Oil Collection Program <br /> A. MODIFICATIONS <br /> The following modifications are to be performed in accordance with all contract <br /> stipulations (specifications, delivery point, rate of delivery, period of performance, price,. <br /> quantity, or other provisions by mutual action of the parties to the contract.) <br /> Effective April 1, 2004, the parties mutually agree to increase the <br /> total amount of compensation by $6 205 00 and use this increase solely <br /> for the nurnoce of onduc ne of r h a : me i sad <br /> oil collection program in the fourth quarter of fiscal year 2004 <br /> All Qoods and services relatine to this public outreach and edur t' <br /> nroeram are to be romn~t d no lat Tnn 90 9004 All ntha r s <br /> .and rnndi ti nnc of th' rr^ t Shall rama' th <br /> Sonrra of Fnnd FY02 FY03 FY04 <br /> S 342 H 000323 371 $55,000.00 $65,000.00 $61,205.00 <br /> B. CONTRACTORlPROVIDER's QUOTATION <br /> The modifications described in A, above, will be performed at a contract <br /> price x increase _ decrease of $ 6,205.00 .The <br /> Contractor/Provider will not undertake to perform the changes in A, above, <br /> until this modification order has been approved d issu d. <br /> Contractiders Signature <br /> C. STATEMENT OF CONTRACT FUNDS <br /> OriginalContradPdce $ 55,000.00 <br /> Previous Adjusted Contract Price $ 175,000.00 <br /> Amount of this Change: Plus X Minus_ 6.205.00 <br /> New Adjusted Contract Price $ ) S) . ~ n S , nn <br /> D. VALIDATION OF CONTRACT MODIFICATION , <br /> Director of Health Date <br /> A50-MOD FORM <br /> (rn. 7/1/99) <br /> <br />