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., for use in construction projects involving an owner, contractor, and engineer. The form is designed to document modifications to existing contracts and includes sections for describing changes to contract scope, attachments supporting the change order, and adjustments to contract price and schedule. The form accommodates both increases and decreases to the original contract terms and tracks cumulative changes through previously approved change orders. The document requires authorization signatures from the engineer, owner, and contractor, with an additional approval line for funding agencies when applicable. The form references the related Penn Township Municipal Building Alterations project in Pennsylvania, which consists of two contracts: General Construction (including demolition, sitework, concrete, and alteration work) and Electrical Construction (including heating and lighting provisions). Bids for this project were received online via PennBid until 10:00 AM on September 3, 2026, with the Notice of Intent to Award to be considered by the Township Board of Supervisors at its September 14, 2026 meeting.
The Change Order Form is a standardized template modified from the EJCDC C-941 document and does not contain specific pricing or timeline information in its blank state. All pricing modifications, schedule adjustments, and substantive completion dates must be populated for each individual change order as needed. The form establishes clear administrative procedures for tracking contract modifications and requires documentation of support materials to justify proposed changes to the original agreement.
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Text version
Herbert, Rowland & Grubic, Inc. 00 63 63 - 1 006566.0459
CHANGE ORDER NO. [X]
Date of Issuance: Effective Date: DATE EXECUTED BY OWNER
Owner: Contract No.:
Contractor: Contract Name:
Engineer: HRG Project No.:
Project:
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 .