Information
Change Order
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Document No.
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Conducted on
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Prepared by
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Location
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Client / Project # and Name
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Change Order Summary
Change Order Details
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Specification No.
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Drawing Sheet No.
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Description
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Price Per Unit of Measure
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Unit of Measure
- Lump Sum
- Each
- Lineal Foot
- Square Foot
- Square Yard
- Cubic Yard
- Tons
- Acre
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Approximate Price
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Will this modification to the contract require a time extension in addition to the dollar value change?
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Length of time added to original contract
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Add drawings or media?
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Drawing
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Photograph
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Additional Comments?
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Additional Comments
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I the undersigned do agree to the above mentioned contract modification along with possible time extension if so applicable.
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Phillip Clouse - Signature
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Owners Representative Signature
