Business Proposal Cover Design - Excel by jeq20592

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									                                                       Jefferson County School District No. R-1
                                                              809 Quail Street, Building #4 / Lakewood, Colorado 80215
                                   Departments of Facilities Planning & Design and Construction Management


                                                                      CHANGE                    ORDER
  CHANGE ORDER #                                                                                                                                 PAGE       1 of 2

                                                                                 Date:
                                                                                P.O.#:
                                                                        Project ID#:
                                                                          Location:

                                                                                 Contractor
           Name:
         Address:




 Project Name:

Provide summary of each work item incorporated into this Change Order. Each item must have supporting data: Proposal,
Quantities, Costs, Reports, etc. MUST BE ATTACHED. (Note: Provide a description of work for each Proposal Request on
the following page or pages)


       Approval:
                                              Contractor Signature
         Position :                                                                           Date:


                                                                     Consultant's Recommendation
This Change Order was originated by the (Contractor, Architect/Engineer, Owner) and I/we do hereby recommend acceptance
and approval of the change to the contract with an (increase, decrease, no change) of

                                                                                                                     Dollars    (              $0.00 )
and                    days extension to the contract time.

  Architect/Engineering Firm :
  By :                                                                                    Date :
                             Consultant Signature



               CONTRACT STATUS                                                APPROVED BY OWNER                                               ONUS
               After this Change Order
                                                                         APPROVAL BY THE OWNER                                 1. Not on Drawings ACME
 Original contract value                  $                              CONSTITUTES ASSURANCE TO THE                          2. Lack of Co-ordination among
                                                                         CONTRACTOR THAT LAWFUL                                   ACME drawings
 Previous increase by CO                  $                              APPROPRIATIONS TO COVER THE COST                      3. Change in scope or
                                                                         OF THE CHANGE ORDER HAVE BEEN                            information by Owner
 Previous decrease by CO                                                 MADE OR THE COST IS COVERED BY A                      4. Dispute Settlement
                                                                         REMEDY-GRANTING PROVISION IN THE                      5. Required by code or
 This CO (increase/decrease)                  $0.00                      CONTRACT DOCUMENTS.                                      other agencies
                                                                                                                               6. Unknown Conditions

                                                                                Signature Project Manager        Date
 Current contract value                               $0.00
                                                                           Signature Construction Management     Date




  13d3e10f-53fa-43e5-936d-6ccf3aceb05e1                                                                                                                         1
                                         Jefferson County School District No. R-1
                                             809 Quail Street, Building #4 / Lakewood, Colorado 80215
                           Department of Facilities Planning & Design and Construction Management
                                              CHANGE ORDER CONTINUATION
CHANGE ORDER #:        0                                                                                            PAGE:         2 of 2
            Date:   1/0/00                                                                                    Project ID #: 0

                                                                                                                                Scheduled
     P.R. NO.                                     Description of Work                                                            Amount
                                                                                                                                            ONUS



1



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9



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14


                                                                                                        Cumulative Total:          $0.00



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     13d3e10f-53fa-43e5-936d-6ccf3aceb05e1

								
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