00 63 63 - Change Order Form.pdf
PDF 281 KB Posted
- Attached to
- WCTA Meter Replacement Project
- Solicitation number
- US.257570
- Issued by
- Lancaster County, Pennsylvania
About this file
This is a change order form prepared by Herbert, Rowland & Grubic, Inc. for use on the WCTA Meter Replacement Project (Contract No. 011364.0448) in West Cocalico Township, Pennsylvania. The form is a blank template based on the modified EJCDC C-941 change order document and is designed to document modifications to the underlying construction contract for the replacement of approximately 790 water meters with new AMI meters across West Cocalico Township. The form provides structured sections to record the description of changes, attachments supporting the change, modifications to contract price and contract times (including substantial completion and ready for final payment dates), cumulative impacts of all approved change orders, and signature lines for authorization by the engineer, owner, and contractor, with an additional approval line for any applicable funding agency.
The change order form includes no predetermined pricing information, as it is a blank template awaiting project-specific data. The document accommodates both increases and decreases to contract price and time, allowing for comprehensive tracking of cost and schedule modifications throughout project execution. Approval authority is distributed among the engineer, owner, and contractor, with provision for additional approval by a funding agency if applicable, ensuring appropriate oversight and authorization protocols are maintained for any modifications to the original contract terms.
View the file
Other files
Show 40 more
Latest 50 of 51 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 011364.0448
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 .