CONTRACT_CHANGE_ORDER.pdf
PDF 51 KB Posted
- Solicitation number
- 24-ENG-02
- Issued by
- Hamilton County, Indiana
About this file
This is a Contract Change Order form from the City of Carmel, Indiana, used to document modifications to an existing construction contract for the Intersection Improvements project at 106th Street and Lakeshore Drive East. The document provides a standardized template for recording changes to contract scope, pricing, and schedule. The change order requires documentation of scheduled adjustment items with associated cost impacts (increases or decreases) and time adjustments in days, and references supporting documents such as Requests for Proposals, Work Direction Codes, and other relevant materials. The form tracks the cumulative effect of changes on both the total contract price and completion date, requiring approval signatures from the engineer, contractor, and city officials including the Presiding Officer and City Engineer.
The change order serves as a mechanism for full and final settlement of all direct, indirect, and impact costs and time extensions resulting from changed work performance. The form includes signature blocks for the Contractor, Engineer (Brad Pease, PE, City Engineer), and City representatives (Laura Campbell as Presiding Officer, with members James Barlow and Alan Potasnik), as well as attestation by Jacob Quinn, Clerk. The document requires both recommended and accepted approvals with corresponding dates and contact information before the change order becomes effective, ensuring proper authorization and documentation of all contract modifications.
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Text version
CITY OF CARMEL
TO: CONTRACT CHANGE ORDER NO.:
DATE:
PROJECT NAME:
CITY REQ. NO.:
CITY PO NO.:
CITY PO DATE: _
I. You are directed to make the following changes in this Contract:
(Brief Description)
SCHEDULED ADJUSTMENT
ITEM AMOUNT (+) OR (-) DAYS
II. The following referenced Documents further describe the changes outlined in Paragraph I, and are to be considered a part of this Change Order: R.F.P.: ________ W.D.C. No.: _______ Other:_____________________________________________________________________
The changes result in the following adjustment of Contract Price and Contract Time:
Contract Price prior to this Change Order $_______________________ Contract Price will be increased/decreased by this Change Order $_______________________ New Contract Price including this Change Order $_______________________ Contract Time Prior to this Change Order ______ Days _______ Completion Date Net increased/decreased resulting from this Change Order_____ Days Current Contract Time including this Change Order_____ Days _______ Completion Date This Change Order is for full and final settlement of all direct, indirect, impact costs and time extensions incurred at any time resulting from the performance of the changed work.
The Above Changes Are Recommended
The Above Changes Are Accepted:
Approved:
ENGINEER CONTRACTOR Laura Campbell, Presiding Officer
Address Address James Barlow, Member
Alan Potasnik, Member
City/State/Zip City/State/Zip Brad Pease, PE, City Engineer
By:
By:
ATTEST:
Phone:__________________ Phone:__________________ Jacob Quinn, Clerk
Date:___________________ Date:___________________ Date: _________________
Version 2024-09-23
File details come from the government source that posted it. Updated .