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FORM 1— GRANT CHANGE LETTER <br />GRANT CHANGE LETTER <br />NUMBER "SAMPLE ONLY" <br />To The <br />AGREEMENT # <br />Between the <br />STATE OF COLORADO <br />DEPARTMENT OF PUBLIC SAFETY <br />DIVISION OF HOMELAND SECURITY AND EMERGENCY MANAGEMENT <br />And <br />INSERT GRANTEE'S FULL LEGAL NAME (CAPITALIZED) <br />Date: I Original Contract #: I Original Contract CMS # I CMS Routin # <br />In accordance with Section of the Original Grant Agreement between the State of Colorado, <br />acting by and through the Department of Public Safety, Division of Homeland security and Emergency <br />Management, and Grantee's Name beginning Insert start date and ending on Insert ending date, the <br />provisions of the Grant and any amendments thereto affected by this Grant Change Letter are modified <br />as follows: <br />1) Project Description. Grantee shall perform the activities listed in the Project Worksheet(s) (PW), <br />which is/are incorporated into the original Grant by reference herein in accordance with the <br />provisions of the Original Grant. <br />Additional PW(s) Budget: <br />Project(s) <br />Project Worksheet <br />(PW#) <br />Federal Share <br />State Cost -Share <br />Grantee Match <br />Requirement <br />Total Project <br />Total <br />Page 1 of 2 — Fonn I <br />