00 63 63 - Change Order Form.pdf
PDF 677 KB Posted
- Solicitation number
- Not on record
- Issued by
- Lancaster County, Pennsylvania
About this file
This is a Change Order Form for the Elizabethtown Area Water Authority's Water Main Replacement Project Phase 4, Contract No. WR-4, with Herbert, Rowland & Grubic, Inc. serving as the engineer and the contractor executing the change order. The form is structured to document modifications to the original contract, including changes to contract price, substantial completion dates, and ready for final payment timelines. The document requires signatures from the engineer, owner, and contractor to authorize the change, with provisions for approval by the funding agency if applicable. The specific details of the change—including the description, supporting attachments, price adjustments, and schedule modifications—are to be inserted in the designated blank fields upon execution.
The form itself does not contain pricing information, set-asides, incumbency details, or funding source specifications, as these elements would be detailed in the original contract documents and the specific change order being executed. This Change Order Form serves as a template based on the Modified EJCDC C-941 standard, prepared and published in 2018 by the Engineers Joint Contract Documents Committee, and is used to formally document and authorize any modifications to the Water Main Replacement Project Phase 4 contract between the Elizabethtown Area Water Authority and the contractor.
View the file
Other files
Show 40 more
Latest 50 of 91 listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Herbert, Rowland & Grubic, Inc. 00 63 63 - 1 009280.0426
CHANGE ORDER 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 Phase 4
The Contract is modified as follows upon execution of this Change Order:
Description: [Description of the change]
Attachments: [List documents supporting change]
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 .