Minnesota State Colleges and Universities
CONSTRUCTION CHANGE ORDER (CO)
FORM MnSCU022
CONTRACT NUMBER: [Insert contract PO number]
CHANGE ORDER NUMBER: _____________
DATE: ______________
PROJECT NAME: _____________________
LOCATION:___________________________
CONTRACTOR:
CONTRACTOR ADDRESS:____________________________
=====================================================================
Contract Number [Insert contract PO number] is hereby amended as follows, and the following Work
is authorized in accordance with the Contract Documents and referenced Modifications when this
Change Order is properly signed by the Architect, Contractor and Owner (hereinafter “MnSCU”) and
funds are encumbered by MnSCU: (Cost breakdowns are required per General Conditions of the
Contract for Construction.)
WHEREAS, MnSCU has an Agreement with the Contractor identified to provide [Give a brief description
of the Scope of the Work provided under the original Construction Contract]; and
WHEREAS, the scope of the Work, Contract Sum or Contract Time have changed due to [Provide
explanations.].......; and
WHEREAS, MnSCU and the CONTRACTOR agree to amend the Agreement as stated below;
THEREFORE,
NO OTHER TERMS OF THE AGREEMENT WILL CHANGE AS A RESULT OF THIS CHANGE ORDER.
NOTE: All information and signatures on page 2 must be fully completed. Full justification for the
requested changes must be included on or attached to this form.
CO.80
Page 1 of 2
12/31/15
CONTRACT SUMMARY:
1. The original Contract Sum was
$________________
2. Previously authorized Change Order additions to date (C.O. Nos:______) $________________
3. Previously authorized Change Order deductions to date (C.O. Nos:____) $________________
4. The Contract Sum prior to this Change Order was
$________________
5. The Contract Sum will be (increased) (decreased) (unchanged) by this
Change Order in the amount of
$________________
6. The new Contract Sum including this Change Order will be
$________________
7. The Contract Time shall be (increased) (decreased) (unchanged) by
________days
8. The date(s) of Substantial Completion as of the date of this Change Order therefore shall be:
[Insert date(s) (mm/dd/yy) of Substantial Completion for each phase, if applicable.]
SIGNATURES OF APPROVAL:
A. ARCHITECT_________________________________
By
Date _______________________
Title _______________________
B. CONTRACTOR
Date _______________________
By
Title _______________________
C. MnSCU
Date _______________________
Authorized Signature
Title _______________________
ENCUMBERED: (For MnSCU use only.) Employee certifies that funds have been
encumbered as required by Minnesota Statute §16A.15.
By ________________________________________________Date _______________________
CO.80
Page 2 of 2
12/31/15