File No.:

Design Change No.:

Contractor:

Vessel:

PWGSC Contract Serial No.:

You are requested to inspect the work specified and to furnish without delay a firm price quotation for carrying out this work.

Description of Design Change or Additional Work:

Detailed specification of work attached as Appendix " "

Delivery Date (YYYY-MM-DD):

Delivery Position:

Signature: _____________________________________

Summary of Cost

Sub-total A and B:

Quebec Applicable Taxes 0.14975

Ontario Applicable Taxes 0.13

East Coast Applicable Taxes 0.15

West Coast Applicable Taxes 0.12

Total Firm Price: Increase or Credit:

Summary of Cost Date (YYYY-MM-DD):

Summary of Cost Position:

Signature: _____________________________________

Inspector's Certification

Inspector's Certification Date (YYYY-MM-DD):

Inspector's Certification Position:

Signature: _____________________________________

Technical Authority Certification

Certified as being technically acceptable and in accordance with the above specified requirements.

Design Authority Certification Date (YYYY-MM-DD):

Design Authority Certification Position:

Signature: _____________________________________

Contracting Authority to Take Work in Hand (PWGSC)

You are hereby authorized to undertake the work as specified in accordance with the contractual terms for the sum of

Authority 1 Date (YYYY-MM-DD):

Authority 1 Position:

Signature: _____________________________________

Clear Data