ADOA_Exhibit_J__Change_Order_ADOA.pdf
PDF 207 KB Posted
- Attached to
- St. Johns Shooting Range Water Retention Project
- Solicitation number
- BPM005756
- Issued by
- Apache County, Arizona
About this file
This is an Arizona Department of Administration (ADOA) Construction Contract Change Order Summary form utilized by state agencies managing construction projects. The document serves as the official template for documenting modifications to construction contracts, requiring authorization from the contractor, design professional, and state procurement officer before becoming effective. The change order form accommodates various modification types, including contractor cost increases for additional work, cost reductions, schedule extensions, and no-cost changes. Contractors must provide comprehensive documentation supporting any proposed changes, including detailed breakdowns of labor, materials, markup, and tax using the accompanying Construction Change Order Worksheet (Exhibit J1). The form captures the original contract sum, previous change orders, net changes proposed, and the resulting new contract sum, along with any adjustments to the project timeline and substantial completion date.
The change order mechanism requires all affected parties to acknowledge that the authorized payment represents full settlement of all claims related to the modification, including any delays or scheduling impacts resulting from the change. The document must be completed with specific project information, including the contract number, project name, state project number, design professional and contractor details, and state project manager information. Upon execution by all required signatories, the change order becomes immediately effective and obligates the contractor to proceed with the approved modifications. This standardized form ensures consistency across Arizona state construction projects and provides clear documentation of contract modifications for financial tracking and project management purposes.
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Text version
Exhibit J
Construction Contract Change Order Summary No. ____
Contract/APP No. Contract/APP Amendment No:
Project Name: State Project No: Statutory Review No:
Design Professional: Contractor: State Project Manager:
ALL OTHER REQUIREMENTS, SPECIFICATIONS, TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Change Order shall modify the Contract only upon the signed approval of the Contractor, Design Professional and State Procurement Officer as specified in the signature block. When signed by all parties, this Change Order becomes effective immediately and the Contractor shall proceed with the change(s) identified and approved.
Page | 1 of 1
1. Check box(es) below best describing the Construction Change Order to the Contract:
☐ Contractor cost increase to Contract due to Additional Work.
☐ Contractor cost reduction to Contract.
☐ Contractor to increase number of calendar days to date of Substantial Completion of the Project.
☐ Contractor “no cost” change to Contract.
☐ Use of Contingency ☐ Other (Provide Description) _______________________________________________________________.
2. Contractor shall provide complete description of reduced or Additional Work, including documents in support of the Change Order (e.g., drawings, material substitution literature, cost reduction or increase detail including breakout of labor, materials, markup and tax). Contractor shall use the Construction Change Order Worksheet (Exhibit J1) to provide a detailed breakdown of any change to the Project Cost.
3. By signing and executing this Change Order, the Contractor and Agency agree to a price 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 Contractor's Work, if any.
Should the Additional Work impact the Schedule, the Agency and Contractor have agreed to extend the date for Substantial Completion as reflected below.
4. Contractor 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 Substantial Completion caused by this Change Order which Contractor or any of its Subcontractors, suppliers 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 construction Change Order.
In accordance with the terms of the Contract, the following detailed changes are proposed:
Original Contract Sum $
Previous Change Orders to Contract $
Net Change for this Change Order to Contract $
New Contract Sum $
Number of Calendar Days for Time Extended for Substantial Completion for this Change Order Days
Revised Substantial Completion Date due to this Change Order
Contractor (Firm Name): Address: Authorized Signature and Date:
Design Professional (Firm Name): Address: Authorized Signature and Date:
State Procurement Officer Name: Agency Name and Address: Authorized Signature and Date:
Chief Compliance Officer Name: Agency Name and Address: Authorized Signature and Date:
State of Arizona General Services Division
100 N 15 Avenue, Suite 103 Phoenix, AZ 85007
Rev 7/19/19
| Construction Contract Change Order Summary No: |
| Contract Amendment No: |
| Project Name: |
| State Project No: |
| Statutory Review No: |
| Design Professional: |
| Contractor: |
| Project Manager: |
| Contractor cost increase to Contract due to Additional Work: Off |
| Contractor cost reduction to Contract: Off |
| Contractor to increase number of calendar days to date of Substantial Completion of the Project: Off |
| Contractor no cost change to Contract: Off |
| Other Provide Description: Off |
| undefined: |
| Construction Order Descr 1: |
| Construction Order Descr 2: |
| Construction Order Descr 3: |
| Original Contract Sum: |
| fill_20: |
| Previous Change Orders to Contract: |
| fill_22: |
| Net Change for this Change Order to Contract: |
| fill_24: |
| New Contract Sum: |
| fill_26: |
| DaysRevised Substantial Completion Date due to this Change Order: |
| Contractor Firm Name: |
| Address: |
| Design Professional Firm Name: |
| Address_2: |
| State Procurement Officer Name: |
| Agency Name and Address: |
| State Lead Building Inspector Name: |
| Agency Name and Address_2: |
| E-Procurment Change Order No: |
| Text6: |
| Construction Order Descr: |
File details come from the government source that posted it. Updated .