3_CHANGE_ORDER_REQUEST_FORM.pdf

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Emergency Drydock Repairs NOAA Ship Okeanos Explorer
Solicitation number
AB-133M-15-RB-0007
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CHANGE ORDER REQUEST FORM

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CHANGE ORDER REQUEST FORM

Solicitation No: AB133M-15-RB-0007 Change Order #_____ Contract No:(TO BE DESIGNATED AT TIME OF AWARD) Applicable Spec. Item _____

DESCRIPTION: SEE ATTACHED SPECIFICATION

Item:

Title:

COST ESTIMATE: (Attach a detailed cost breakdown for changes estimated to exceed 25 labor hours or containing subcontracts exceeding $500.00.)

Direct Labor: ________Regular MH @$__________ = $__________

________OT @$__________ = $__________

Total Direct Labor = $__________

Material/Subcontract_________________________________________________________

Total Material Cost $___________ Markup @ ___% = $___________

Total Material $___________

Total for Item $___________

Effect on Completion Time (Provide Justification if Extension is Requested):

Signature Date

Action Requested By: __________________________

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