00 63 49 - Work Change Directive Form.pdf
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- Solicitation number
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- Lancaster County, Pennsylvania
About this file
This is a Work Change Directive Form template used by Herbert, Rowland & Grubic, Inc. (HRG), the engineer for the Elizabethtown Area Water Authority's Water Main Replacement Project Phase 4 (Contract No. WR-4). The form provides a standardized process for issuing change directives to contractors during the construction phase of the project. The directive allows the contractor to proceed with work changes prior to final agreement on contract price and time adjustments, with changes documented through descriptions, supporting attachments, and stated purposes. The form identifies two primary reasons for issuing change directives: non-agreement on pricing of proposed changes or necessity to proceed for schedule or other project-related reasons. Contract price adjustments may be structured as lump sum, unit prices, cost of work, or other methods, with time adjustments measured in days for either increases or decreases.
The form requires authorization and approval signatures from the engineer, owner, and funding agency, with all parties documenting the date of issuance and effective date for each change directive. Preliminary and non-binding estimates for changes in contract price and contract time are provided on the form, allowing the parties to establish a framework for negotiations while work proceeds. This template ensures that change management during the Water Main Replacement Project Phase 4—which involves relocation of approximately 13,860 feet of DIP water main, replacement of fifteen fire hydrants, and transfer of approximately 180 existing water services—maintains proper documentation and authorization protocols throughout the construction process.
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Text version
Herbert, Rowland & Grubic, Inc. 00 63 49 - 1 009280.0426
WORK CHANGE DIRECTIVE NO. XX
Date of Issuance: Effective Date: [DATE EXECUTED BY OWNER]
Owner: Elizabethtown Area Water Authority Contract No.: WR-4
Contractor: Contract Name:
Engineer: Herbert, Rowland, & Grubic, Inc. HRG Project No.: 009280.0426
Project: Water Main Replacement Project Phase 4
Contractor is directed to proceed promptly with the following change(s):
Description: [Description of the change to the Work]
Attachments: [List documents supporting change]
Purpose for Work Change Directive: [Describe the purpose for the change to the Work]
Directive to proceed promptly with the Work described herein, prior to agreeing to changes on Contract Price and Contract Time, is issued due to: NOTE - check one or both of the following
Non-agreement on pricing of proposed change Necessity to proceed for schedule or other Project reasons.
Estimated Change in Contract Price and Contract Times (non-binding, preliminary):
Contract Price: $ [increase] [decrease] [not yet estimated].
Contract Time: days [increase] [decrease] [not yet estimated].
Basis of determining change in Contract Price:
Lump Sum Unit Prices Cost of the Work Other
RECOMMENDED: AUTHORIZED BY: APPROVED (if applicable):
By: By: By:
Engineer (Authorized Signature) Owner (Authorized Signature) Funding Agency
Title: Title: Title:
Date: Date: Date:
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