MINNESOTA STATE COLLEGES AND UNIVERSITIES - DOC by nl8NhaO

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									(For MnSCU use only.)                                                                          Form MnSCU022

              FY     Cost Center #   Obj. Code     $ Amount           Vendor #                   P.O. #
Original
C.O. No.
Total

                    MINNESOTA STATE COLLEGES AND UNIVERSITIES

                    CHANGE ORDER FOR CONSTRUCTION CONTRACT

CONTRACT NUMBER:_________________                             CHANGE ORDER NUMBER: _____________
                                                                             DATE:______________

PROJECT NAME:                                                 CONTRACTOR:
LOCATION:                                                     ADDRESS:
=====================================================================
Contract Number                   is hereby amended as follows, and the following Work is authorized in
accordance with the Contract Documents and referenced Modifications when this Change Order is properly signed
by the Architect, CONTRACTOR and OWNER (hereinafter “MnSCU”) and funds are encumbered by MnSCU:
(Cost breakdowns are required per Conditions of the Contract for Construction.)

WHEREAS, MnSCU has an Agreement with the CONTRACTOR identified to provide [Give a brief description of the
Scope of the Work provided under the original Agreement for Construction Services]; and


WHEREAS, the scope of the Work, Contract Sum or Contract Time have changed due to [Provide explanations.].......; and

WHEREAS, MnSCU and the CONTRACTOR agree to amend the Agreement as stated below;

THEREFORE,




Rev. 4/1/09                                    Page 1 of 3
NO OTHER TERMS OF THE AGREEMENT WILL CHANGE AS A RESULT OF THIS CHANGE ORDER.
NOTE: All information and signatures on page 2 must be fully completed. Full justification for the requested 022
                                                                                                 Form MnSCU
      changes must be included on or attached to this form.




Rev. 4/1/09                                  Page 2 of 3
    CONTRACT NUMBER:_________________                                CHANGE ORDER NUMBER:__________
                                                                                     Form MnSCU 022

     CONTRACT SUMMARY:

     1. The original Contract Sum was……………………………………………………….$________________

     2. Previously authorized Change Order additions to date (C.O. Nos:___________)…...$________________

     3. Previously authorized Change Order deductions to date (C.O. Nos:___________)....$________________

     4. The Contract Sum prior to this Change Order was…………………………………...$________________

     5. The Contract Sum will be (increased) (decreased) (unchanged) by this Change
            Order in the amount of…………………………………………………………..$________________

     6. The new Contract Sum including this Change Order will be………………………....$________________

     7. The Contract Time shall be (increased) (decreased) (unchanged) by…………………._____________days

     8. The date(s) of Substantial Completion as of the date of this Change Order therefore is________________




     SIGNATURES OF APPROVAL:

     A. ARCHITECT____________________________________                 Date _______________________

         By                                                           Title _______________________


     B. CONTRACTOR                                                    Date _______________________

         By                                                           Title _______________________


     C. MnSCU                                                         Date _______________________

         Authorized Signature                                         Title _______________________




       ENCUMBERED: (For MnSCU use only.) Employee certifies that funds have been encumbered as
       required by Minnesota Statute §16A.15.


     By _________________________________________________ Date _______________________




Rev. 4/1/09                                   Page 3 of 3

								
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