Change_Order_Form.pdf
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- Solicitation number
- 2025-ITB-002
- Issued by
- Doña Ana County, New Mexico
About this file
This document is a Contract Change Order form for the Gallup Municipal Airport Runway 6/24 rehabilitation project, involving the Federal Aviation Administration (FAA), New Mexico Department of Transportation (NMDOT), and Armstrong (a Lockheed Martin company). The form is designed to document and approve modifications to the original contract, with specific fields for describing proposed changes, including item descriptions, quantities, unit prices, and total contract adjustments. The change order requires approval from multiple parties including the Engineer, Owner, Contractor, State Aviation, and Federal Aviation Administration.
The form includes provisions for documenting the financial impact of contract changes, with sections for calculating the change order total, previous change orders, original contract price, and revised contract total. It also requires justification for the proposed changes, including brief descriptions, reasons for changes, and unit price or total cost justifications. Additional administrative details include verifying wage rate decisions, obtaining surety consent, assessing insurance coverage implications, and confirming discussions with FAA officials. The document emphasizes that FAA approval is mandatory prior to construction, and without such approval, no federal participation can be granted.
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Text version
Contract Documents CO-1 247024 Gallup Municipal Airport
CONTRACT CHANGE ORDER NO. _____
or
SUPPLEMENTAL AGREEMENT NO. _____
AIRPORT: Gallup Municipal Airport DATE:
LOCATION: Gallup, New Mexico AIP NO.: 3-35-0019-031-2024
CONTRACTOR:
You are requested to perform the following described Work upon receipt of an approved copy of this document or as directed by the Engineer:
ITEM
NO. DESCRIPTION UNIT UNIT
PRICE QUANTITY AMOUNT
This Change Order Total $
Previous Change Order(s) Total $
Original Contract Price $
Revised Contract Total $
The time provided for completion in the Contract is (unchanged) (decreased) (increased) by calendar days. This document shall become an Amendment to the Contract and all provisions of the Contract will apply. Changes are shown on the attached Quantities Tabulation.
Recommended by:
Engineer Date
Approved by:
Owner Date
Accepted by:
Contractor Date
Approved by:
State Aviation Date
Approved by: See Page CO-2 Federal Aviation Administration Date
NOTE: Change Orders and Supplemental Agreements require FAA approval prior to construction.
Otherwise, no Federal participation can be granted. State Aviation concurrence is required when State participation is anticipated.
Contract Documents CO-2
AIP NO.: 3-35-0019-031-2024 CHANGE ORDER NO.: _________
AIRPORT: Gallup Municipal Airport LOCATION: Gallup, New Mexico
FAA Approval:
[ ] This approval is subject to the availability of Federal funds and limitations of the Grant Agreement.
[ ] This approval is subject to the availability of Federal funds and limitations of the Grant Agreement and comments in our letter dated __________________.
[ ] This approval is for record purposes only, with no Federal participation.
By:
Program Manager, NM-ADO Date
NOTE: Change Orders and Supplemental Agreements require FAA approval prior to construction.
Otherwise, no Federal participation can be granted.
Contract Documents CO-3
AIP NO.: 3-35-0019-031-2024 CHANGE ORDER NO.
AIRPORT: Gallup Municipal Airport LOCATION: Gallup, New Mexico
JUSTIFICATION FOR CHANGE
1. Brief description of the proposed Contract change(s) and location(s).
2. Reason(s) for the change(s). (Continue on reverse if necessary.)
3. Justifications for Unit Prices or Total Cost.
4. The Sponsor's share of this cost is available from:
5. If this is Supplemental Agreement involving more than $2,000, is the Cost Estimate based on the latest wage rate decision? Yes No Not Applicable ___
6. Has Consent of Surety been obtained? Yes No Not Applicable ___
7. Will this change affect the insurance coverage? Yes No ___
8. If yes, will the policies be extended? Yes No ___
9. Has this Change Order been discussed with FAA officials?
Yes No When With Whom
Comment
Submit four executed copies to the FAA.
File details come from the government source that posted it. Updated .