19-Doc 00 63 63 - Change Order.pdf
PDF 91 KB Posted
- Attached to
- 1121 Horsham Road Demolition (26-01054)
- Solicitation number
- US.258594
- Issued by
- Pennsylvania
About this file
This is a Change Order form (EJCDC Form C-941) issued by Horsham Township, Pennsylvania for the 1121 Horsham Road Demolition project (Contract No. 2026-01054). The change order document provides a standardized template for documenting modifications to the original contract agreement between Horsham Township (Owner), Gilmore & Associates, Inc. (Engineer), and the Contractor. The form includes designated sections for describing the nature of changes required, the reason for the modification, and supporting attachments, with fields to record the impact on contract price and schedule, including substantial completion dates and readiness for final payment. Signature blocks are provided for recommendations by the Engineer, approvals by the Owner, and acceptance by the Contractor, with corresponding date fields to ensure proper authorization and documentation of the change order.
The document serves as a framework for tracking cumulative financial and schedule adjustments to the original contract. It contains line items to record the original contract price and timeline, net changes from any previous change orders, and the revised contract totals after approval of the current change order. The form does not contain specific pricing, time adjustments, or change descriptions in this instance, as it represents a blank template. No pricing terms, set-asides, incumbent information, or funding source details are specified in this particular change order document.
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Text version
DOCUMENT 00 63 63
No.
PROJECT:
DATE OF ISSUANCE EFFECTIVE DATE
OWNER:
OWNER'S Contract No.
CONTRACTOR: ENGINEER:
You are directed to make the following changes in the Contract Documents.
Description:
Reason for Change Order:
Attachments:
Original Contract Price Original Contract Times
Substantial Completion:
$ Ready for final payment:
Net changes from previous Change Orders No. to No. Net changes from previous Change Orders No. to No.
$ days
Contract Price prior to this Change Order Contract Times prior to this Change Order
Substantial Completion:
$ Ready for final payment:
Net increase (decrease) of this Change Order Net increase (decrease) of this Change Order
$ days
Contract Price with all approved Change Orders Contract Times with all approved Change Orders
Substantial Completion:
$ Ready for final payment:
RECOMMENDED: APPROVED: ACCEPTED:
By: By: By:
Date: Date: Date:
CHANGE ORDER
Horsham Township
2026-01054
Gilmore & Associates, Inc.
Engineer (authorized signature)
CHANGE IN CONTRACT PRICE: CHANGE IN CONTRACT TIMES:
Owner (authorized signature) Contractor (authorized signature)
EJCDC Form C-941
CHANGE ORDER
00 63 63-1
File details come from the government source that posted it. Updated .