Colorado Department of Labor and Employment

Division of Oil and Public Safety

Colorado Petroleum
Storage Tank Fund

Listed Consultant Program– Form MHN
Client Notification
Article 2, Part 4

The undersigned consultant and consultant’s client hereby state that the consultant has provided to the client a copy of Colorado’s Reasonable Cost Guidelines, and that the client has been advised that any otherwise allowable costs billed at rates exceeding those set forth in the Reasonable Cost Guidelines may not be reimbursed to the client at a rate higher than the rate in the Guidelines if the Petroleum Storage Tank Committee does not consider the higher rate to be justified.

CONSULTANT: CLIENT:
Company name:  Company/individual name:
Consultant listed number or mailing address
(if not listed):

 

 

 Mailing address:

 

 
By

(Signature of authorized representative)

  

By

(Signature of individual or authorized
representative)
Date signed: Date signed:
Print name and title of authorized representative:

 

 Print name and title of authorized representative:

 

RETURN A COPY OF THIS SIGNED FORM WITH THE ORIGINAL
FUND REIMBURSEMENT APPLICATION
SUBMITTED BY THIS CLIENT
FOR WORK PERFORMED BY THIS CONSULTANT


Note:  It will not be the necessary to submit the MHN for subsequent supplementals as long as the consultant remains the same.


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Last modified:  January 25, 2005