Sample Only
CITY OF PORT ANGELES
PUBLIC WORKS DEPARTMENT
CONTRACT CHANGE ORDER NO.
SHEET ___ OF ___
Project Name DATE:
Contractor
Project No. LID No. State/Fed. Aid No.
DESCRIPTION OF WORK
You are ordered to perform the following described work upon receipt of an approved copy of this Change Order:
Such work will be compensated by: [ ] Increase or [ ] Decrease in bid items; [ ] Force Account; [ ] Negotiated Price: The described work affects the existing contract items and/or adds and/or deletes bid items as follows:
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Item No. |
Description |
DCVR # |
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Quantity |
Unit |
*$ Cost Per Unit |
*$ Cost |
*Net $ Cost |
Adj. Days |
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Orig. |
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Rev. |
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Orig. |
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Rev. |
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Orig. |
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Rev. |
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Orig. |
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Rev. |
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* ORIGINAL CONTRACT |
* CURRENT CONTRACT |
* EST. NET CHANGE THIS CHANGE ORDER |
TOTAL CHANGE ORDERS, INCLUDING THIS ONE |
EST. CONTRACT AFTER THIS CHANGE ORDER |
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$ |
$ |
$ |
$ |
$ |
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DAYS: |
DAYS: |
DAYS: |
DAYS: |
DAYS: |
* Sales Tax Not Included
All work, materials and measurements to be in accordance with the provisions of the original contract and/or the standard specifications and special provisions for the type of construction involved. The payments and/or additional time specified and agreed to in this order include every claim by the Contractor for any extra payment or extension of time with respect to the work described herein, including delays to the overall project.
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APPROVED BY: |
SIGNATURE: |
DATE: |
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ARCHITECT/ENGINEER |
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PROJECT ENGR./CITY ENGINEER |
/ |
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CONTRACTOR |
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PUBLIC WORKS DIRECTOR |
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CITY MANAGER |
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CITY COUNCIL APPROVAL DATE: |
PW-404_04 [10/95]