EXTRA WORK ORDER

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

CONTRACTOR IS DIRECTED TO COMPLETE THE FOLLOWING EXTRA WORK CHANGES IN CONTRACT DOCUMENTS
SCOPE
DESCRIPTION
PAYMENT TERMS AND IMPACT ON PAYMENT PROGRESS
SPECIFICATIONS AND OTHER PROVISIONS

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

EXTRA WORK DISCUSSION DOCUMENTATION | WORK / CHANGE HAS BEEN DISCUSSED WITH
NAME & TITLE	NAME & TITLE	DATE
By
By
By
By

ACCEPTED BY CONTRACTOR	APPROVED BY OWNER
DATE	DATE