CHANGE ORDER

PROJECT NAME
LOCATION OF WORK
CONTRACT NO.	CHANGE ORDER NO.
REQUESTING PARTY	DATE OF REQUEST
PROJECT MANAGER	CONTRACTOR
OWNER	ENGINEER

CHANGE REQUEST OVERVIEW
DESCRIPTION OF CHANGES NEEDED
REASON FOR CHANGE
SUPPORT AND JUSTIFICATION DOCUMENTS	List all attached documents that support the requested change and justify any increased cost and time.
SPECIFICATIONS

CHANGE IN CONTRACT PRICE	CHANGE IN CONTRACT TIMES
ORIGINAL PRICE	ORIGINAL TIMES
NET CHANGES OF PREVIOUS CHANGE ORDERS	NET CHANGES OF PREVIOUS CHANGE ORDERS IN DAYS
NET INCREASE / DECREASE	NET INCREASE / DECREASE
TOTAL CONTRACT PRICE WITH APPROVED CHANGES	TOTAL CONTRACT TIME WITH APPROVED CHANGES

RECOMMENDED BY ENGINEER	APPROVED BY OWNER
DATE	DATE
ACCEPTED BY CONTRACTOR	REVIEWED BY FUNDER
DATE	DATE

PROJECT NAME
LOCATION OF WORK
CONTRACT NO.	CHANGE ORDER NO.

ITEMIZED BREAKDOWN OF WORK
MATERIAL NAME	DESCRIPTION	QUANTITIY	UNIT PRICE	AMOUNT
TOTAL
LABOR	NO. OF HRS	RATE	AMOUNT
REGULAR PAY
OVERTIME PAY
TOTAL	TOTAL
EQUIPMENT	NO. OF HRS	RATE	AMOUNT
RENTED
OWNED
TRUCKING
TOTAL
OVERHEAD (MATERIAL, LABOR, & EQUIPMENT TOTAL)	x 15%
SUBCONTRACTORS	NO. OF HRS	RATE	AMOUNT
SUBCONTRACTOR 1
SUBCONTRACTOR 2
SUBCONTRACTOR 3
TOTAL
GRAND TOTAL

CONTRACTOR SIGNATURE	PROJECT MANAGER SIGNATURE
DATE	DATE

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