00 63 63 - Change Order Form.pdf
PDF 273 KB Posted
- Attached to
- Skytop Lodge Sewage Treatment Plant Improvements Project – Contract : 2026-01- Project Number 005153. 0436
- Solicitation number
- Not on record
- Issued by
- Monroe County, Pennsylvania
About this file
This is a Change Order Form for the Skytop Lodge Sewage Treatment Plant Improvements Project, involving Skytop Lodge, Inc. as the owner and Herbert, Rowland & Grubic, Inc. as both the engineer and contractor. The project, identified as Contract 2026-01 with Project Number 005153.0436, encompasses sewage treatment plant upgrades including installation of an influent screening system, equalization tank, chemical feed system, two clarifier tanks, a post aeration tank, UV disinfection system, and related work. Bids for the original construction contract were publicly opened on September 18, 2026, at 10:00 AM through PennBid, with a pre-bid conference held on August 25, 2026, at 10:30 AM at the Skytop Lodge STP facility in Canadensis, Pennsylvania. Bid security of not less than 10% was required in the form of a certified check or bid bond.
The Change Order Form provides a template for modifying the original contract price and schedule, with designated fields for documenting increases or decreases in contract price and contract times including substantial completion and ready for final payment dates. The form requires authorized signatures from the engineer, owner, and contractor, with provisions for funding agency approval if applicable. Specific dollar amounts, time modifications, and change order numbers are to be completed upon execution, allowing for adjustments to the original contract terms as project conditions warrant.
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Text version
Herbert, Rowland & Grubic, Inc. 00 63 63 - 1 005153.0436
CHANGE ORDER NO.
Date of Issuance: Effective Date: DATE EXECUTED BY OWNER
Owner: Skytop Lodge, Inc. Contract No.:
Contractor: Contract Name:
Engineer: Herbert, Rowland and Grubic, Inc. HRG Project No.: 005153.0436
Project: Skytop Lodge Sewage Treatment Plant Improvements Project
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:
File details come from the government source that posted it. Updated .