DISPUTE NOTICE, EFFORTS TO SETTLE HAVE FAILED

Date

Mr. Contracting Officer

(Address)

Re: Request for Equitable Adjustment

(Subject)

Contract number

Dear Sir:

Regarding my Request for Equitable Adjustment dated , it appears that efforts to settle with you 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.