ADOA_Exhibit_F_Design_Change_Notice_ADOA.pdf
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- Attached to
- St. Johns Shooting Range Water Retention Project
- Solicitation number
- BPM005756
- Issued by
- Apache County, Arizona
About this file
This is a Design Change Notice form from the State of Arizona General Services Division, applicable to design professional contracts under state oversight. The document serves as a formal change order mechanism for modifications to design contracts, requiring approval from the Design Professional, State Lead Building Inspector, and State Procurement Officer before implementation. Upon execution by all required parties, the Design Change Notice becomes immediately effective and authorizes the Design Professional to proceed with identified changes. The form requires complete documentation of Design Professional services for additional work, including cost estimates with labor and reimbursable expense breakdowns when applicable.
The Design Change Notice establishes a firm, not-to-exceed price for all additional work, including costs associated with design delays if the change impacts the project schedule. The form accommodates schedule extensions with specific calendar days designated for extended design completion timelines. The Design Professional agrees that payment authorized by the Change Order constitutes full settlement of all claims related to the additional work, including those arising from delays to design completion. The document includes fields for tracking the original contract sum, previous change orders, additional work fees, reimbursable expenses, and the resulting new contract sum, ensuring transparent financial accounting throughout the contract modification process.
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Text version
Exhibit F - Design Change Notice State of Arizona General Services Division
100 N 15th Avenue, Suite 103 Phoenix, AZ 85007
Contract/ APP No.
DCN No. Contract/APP Amendment No:
Project Name: Agency Project No: Statutory Review No:
Design Professional: Contractor: State Project Manager:
ALL OTHER REQUIREMENTS, SPECIFICATIONS, TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Design Change Notice shall modify the Contract only upon the signed approval of the Design Professional, State Lead Building Inspector, and State Procurement Officer as specified in the signature block. When signed by all parties, this Design Change Notice becomes effective immediately and the Design Professional shall proceed with the change(s) identified and approved.
Page | 1 of 1
1. The Design Change Notice is a type of Change Order under the Contract.
2. Design Professional to provide complete description of Design Professional Services to be included in Additional Work including documents in support of the Change Order such as, estimates of cost including breakout of labor and reimbursable expenses (if additional costs are applicable). Attach proposal if additional costs are applicable.
3. By signing and executing this Change Order, the Design Professional and Agency agree to a price, not to be exceeded, for the Additional Work, as detailed below. This price shall cover any and all Costs associated with the Additional Work including, but not limited to, Costs associated with delay of the Design Professional’s Work, if any. Should the Additional Work impact the Schedule, the Agency and Design Professional have agreed to extend the date for completion of design Work as reflected below.
4. Design Professional agrees that the payment authorized by this Change Order, if any, is in full settlement of any and all causes of action, including but not limited to, any claim resulting from delays to the time to design completion caused by this Change Order which Design Professional or any of its Subconsultants, and the officers, agents, and employees of each of them, may now have or may assert in the future against the Agency, or its officers, employees and agents, arising out of, or associated with, this Change Order.
Design Professional (Firm Name): Construction Compliance Officer Name: State Procurement Officer Name:
Address: Address: Agency and Address:
Authorized Signature and Date: Authorized Signature and Date: Authorized Signature and Date:
Original Contract Sum including Reimbursable Expenses $ Previous Change Orders to Contract $ Design Change Order Additional Work Fee to Contract $ Additional Reimbursable Expenses for this Change Order, NOT TO EXCEED AMOUNT $ New Contract Sum $ Number of Calendar Days for Time Extended for Design Completion Days
Rev. 8/5/19
| Contract No: |
| Eprocurement Change Order No: |
| Contract Amendment No: |
| Project Name: |
| Agency Project No: |
| Statutory Review No: |
| Design Professional: |
| Contractor: |
| Project Manager: |
| State Lead Building Inspector Name: |
| Design Professional Firm Name: |
| State Procurement Officer Name: |
| Address: |
| Address_2: |
| Agency and Address: |
| Extended Days: |
| New Contract Sum: |
| Additional Reimbursable Expenses: |
| Additonal Work Fee to Contract: |
| Previous Change Order to Contract: |
| Original Sum: |
| State Procurement Officer Signature: |
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