00 63 63 - Change Order Form.pdf
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- Solicitation number
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- Lancaster County, Pennsylvania
About this file
This is a Change Order Form prepared by Herbert, Rowland & Grubic, Inc. (Engineer) for the Borough of Elizabethtown related to Contract No. 2026-01, the Sewer Maintenance & Emergency Contract. The change order document serves as a template for modifying the terms of the existing contract and includes sections for documenting changes to contract price and contract times, including substantial completion dates and readiness for final payment dates. The form requires authorization signatures from the Engineer, Owner (Borough of Elizabethtown), and Contractor, with an optional signature line for the Funding Agency. The document is based on the modified EJCDC C-941 Change Order template published in 2018 by the Engineers Joint Contract Documents Committee.
The change order form itself does not contain completed pricing information, specific scope modifications, or execution dates, as it appears to be a blank template awaiting completion. No specific details regarding increase or decrease amounts, previous change orders, or contract price adjustments are populated in this version of the document. The form is designed to track cumulative contract modifications from the original agreement through all approved change orders, providing a systematic method for managing contract changes throughout the project duration.
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Text version
Herbert, Rowland & Grubic, Inc. 00 63 63 - 1 000598.0465
CHANGE ORDER NO. X
Date of Issuance: Effective Date:
Owner: Borough of Elizabethtown Contract No.: 2026-01 Contractor: Contract Name:
Engineer: Herber, Rowland & Grubic, Inc. HRG Project No.: 000598.0465
Project: Sewer Maintenance & Emergency Contract
The Contract is modified as follows upon execution of this Change Order:
Description:
Attachments:
CHANGE IN CONTRACT PRICE CHANGE IN CONTRACT TIMES
[note changes in Milestones if applicable]
Original Contract Price: Original Contract Times:
Substantial Completion: _______________________ $ Ready for Final Payment: _______________________ days or dates
[Increase] [Decrease] from previously approved Change Orders No. to No. :
[Increase] [Decrease] from previously approved Change Orders No. to No. :
Substantial Completion:
$ Ready for Final Payment:
days
Contract Price prior to this Change Order: Contract Times prior to this Change Order:
Substantial Completion:
$ Ready for Final Payment:
days or dates
[Increase] [Decrease] of this Change Order: [Increase] [Decrease] of this Change Order:
Substantial Completion:
$ Ready for Final Payment:
days or dates
Contract Price incorporating this Change Order: Contract Times with all approved Change Orders:
Substantial Completion:
$ Ready for Final Payment:
days or dates
RECOMMENDED: AUTHORIZED BY: RECEIVED:
By: By: By:
Engineer (Authorized Signature) Owner (Authorized Signature) Contractor (Authorized Signature)
Title: Title: Title:
Date: Date: Date:
Approved by Funding Agency (if applicable)
By: Date:
Title:
Modified EJCDC® C-941, Change Order. Prepared and published 2018 by the Engineers Joint Contract Documents Committee.
File details come from the government source that posted it. Updated .