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Contractor Change Order Form - Excel

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Contractor Change Order Form document sample

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									                    UBC Plant Operations                                                                      RECORD OF CHANGE
                   LBS Projects Services
                                                                                                                               (Contractor)
                   2329 West Mall
                   Vancouver, BC Canada V6T 1Z4
                   Tel: (604) 822-2172 Fax: (604) 822-6969                                                          Change Order No.:
 Project:                                                                                                           Contract No.:
 Location:                                                                                                          Date:
 Project Manager:                                                                                                   Project No.:
 Contractor:                                                                                                        Construction W/R No.:           (incl. phase #)
 Design Leader:                                                                                                     Contingency W/R No.:            (incl. phase #)

 CONTEMPLATED CHANGE ORDER
 The following describes proposed changes to the construction documents for this project. Unless noted below, work is not to proceed until authorization
 by way of a Change Order is received. All material and workmanship are to be as described in the construction documents unless otherwise stated. The
 Contractor is to return a signed copy of this form to the Design Leader within five (5) working days with the impacts to the construction price and
 completion filled out below and a cost breakdown on Contractor's letterhead attached thereto.
 Description of Change: (refer also to attachments for details)




 Reason for Change:



 Initiated By:          Design Leader             Consultant       Contractor             Project Manager      Client                   Other:
 Prepared By:                              Signature                           Name                          Position                            Date
 (Design Leader/Consultant)

 Impact on Construction: (to be completed by Contractor - refer to attached cost breakdown)
 The Construction Price will have to be                        increased by:                 reduced by:        $
 Construction completion will have to be                       extended by:                  shortened by:                                       working days
 Estimated By:                             Signature                           Name                          Position                            Date
 (Contractor)

 CHANGE ORDER
 The following authorizes changes to the construction documents for this project as described above.
 The Construction Price is hereby                              increased by:                 reduced by:       $
 Comments

 Original Contingency:                                  $                             Original Contract Price:                               $
 Less: Contingency Used To Date:                       -$                             Changes to Date:                                       $
 Less: This Charge:                                    -$                             This Change:                                           $
 Remaining Contingency:                                 $                             Revised Contract Price:                                $
 Recommended By:                           Signature                           Name                          Position                            Date
 (Design Leader/Consultant)
 Reviewed By:                              Signature                           Name                          Position                            Date
                                                                                                                Design Manager
 Reviewed/Approved By:                     Signature                           Name                          Position                            Date
                                                                                                                Project Manager
 Associate Director                        Signature                           Name                          Position                            Date
 Approval (Scope Change*)                                                                                       A/D Project Services
 Client/Project Leader                     Signature                           Name                          Position                            Date
 Approval (Scope Change*)

 * - Budget Amendment form also to be filled out, attached for Client/Project Leader approval

 Copies to:
      Project Manager                           Design Leader/Consultant              Contractor                    Cable Facilities             Client/Project Leader
      Fax:      822-0857                        Fax:                                  Fax:                          Fax:          822-2108       Fax:
      Projects Data Clerk                                                                                                                        Work Control
                                                Fax:                                  Fax:                          Fax:                         Fax:          822-6969




8920d027-cbff-417a-9099-f071207978d0.xls

								
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