This sample amendment is adaptable for use by Louisiana state agencies and contains the
minimum language required. Additional information may be added as required by the
individual agency's needs and applicable federal requirements.

Office of Contractual Review # ______________


CFMS # ______________


Amendment #  ______________

Change Agreement from:

ADD OR CHANGE TO: (if increase indicate reason)


(Justification for amendment increase or extension)

No amendment shall be valid until it has been executed by all parties and approved by
the Director of the Office of Contractual Review, Division of Administration.

This amendment contains or has attached hereto all revised terms and conditions
agreed upon by contracting parties. IN WITNESS THEREOF, this amendment
is signed and entered into on the date indicated below:

_______________________________ __________
(Contractor's Signature) (Date)

Contractor's Name: _________________________

Contractor's Title: __________________________

_______________________________ __________
(Agency Signature) (Date)

Agency's Name: ____________________________

Agency's Title:______________________________