SCOPE OF WORK CHANGE ORDER

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

ITEMIZED CHANGES
WORK ORDER ITEM	ADD / DELETE / CHANGE IN COST	ORIGINAL COST	FINAL COST
TOTAL
REMOVED FROM ORIGINAL SOW
MODIFIED FROM ORIGINAL SOW
PAYMENT TERMS AND IMPACT ON PAYMENT PROGRESS
IMPACT TO SCHEDULE	Include revised timeline.

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

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