DISPUTE, PASS-THROUGH TO GOVERNMENT

(SUB-CONTRACTOR)

Date

Mr. Prime Contractor

(Address)

Re: Notice of Dispute

(Subject)

Contract number

Dear Sir:

Regarding my Request for Change Order dated , it appears that efforts to settle have failed. If I do not receive a contract modification for the amount of $ and a time extension of days within seven (7) days, I will consider this matter to be in dispute.

Although I believe the Government to be responsible for this change, my contract is with you and I must reserve my rights to pursue this matter against you, should efforts to obtain fair compensation from the Government fail.