ENGINEERING CHANGE ORDER

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

CHANGE OVERVIEW
DRAWING / DESCRIPTION OF CHANGE	List and attach any pertinent documentation.
REASON FOR CHANGE
ACTIONS REQUESTED
SUPPORT AND JUSTIFICATION DOCUMENTS	List all attached documents which support the requested change, and justify any increased cost and time.
PRELIMINARY ENGINEERING
CONSTRUCTION ENGINEERING
SUMMARY OF ASSUMPTIONS AND RISKS
ITEMS IMPACTED

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

ITEMIZED BREAKDOWN OF WORK
NO. OF HRS	RATE	AMOUNT
CONSTRUCTION
DESIGN ALLOCATION
OTHER
TOTAL
TAX	x 15%
GRAND TOTAL

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