PROJECT CHANGE ORDER REQUEST FORM

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

PROJECT DETAILS

PROJECT CHANGE REQUEST DESCRIPTION
DESCRIPTION OF CHANGES NEEDED
REASON FOR CHANGE
SUPPORT & JUSTIFICATION DOCUMENTS	List all attached documents which support the requested change and justify any increased cost and time.
SPECIFICATIONS
IMPACT OF CHANGE
RISK MANAGEMENT

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

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

CHANGE REQUEST PRIORITY LEVEL	PRIORITY LEVEL JUSTIFICATION

PROJECT CHANGE ORDER DISCUSSION DOCUMENTATION

CHANGE HAS BEEN DISCUSSED WITH:

NAME & TITLE	NAME & TITLE	DATE
By
By
By
By
By
By

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

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