JOB NAME:__________________________ ADDRESS:_______________________
CHANGE ORDER NUMBER____________
DESCRIPTION OF WORK TO BE DONE AMOUNT
___________________________________________________________________ ___________
___________________________________________________________________ ___________
___________________________________________________________________ ___________
___________________________________________________________________ ___________
___________________________________________________________________ ___________
TOTAL MAN HOURS:_________________ CHANGE ORDER AMOUNT: ___________
ORIGINAL CONTRACT AMT $__________________
NET CHANGES BY PREVIOUS CHANGE ORDERS $__________________
CONTRACT SUM PRIOR TO THIS CHANGE ORDER $__________________
THIS CHANGE ORDER AMOUNT $__________________
ADJUSTED CONTRACT AMOUNT $__________________
CONTRACT TIME WILL BE (INCREASED/DECREASED) BY _______DAYS.
THE DATE OF SUBSTANTIAL COMPLETION AS OF THE DATE OF THIS CHANGE ORDER THEREFORE
IS:________________________
_____________________________________ __________________________
SIGNATURE OF SUBCONTRACTOR DATE
DATE REQUESTED TO BEGIN:____________AUTHORIZED BY:________________________
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Office Use:
SIGNED BY:_____________________________ DATE:___________________________________
CATEGORY ITEM/BACK CHARGE/EXTRA:______________________________