Project Name: Contract Date Contract No.: Project Number:

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CONTRACT CHANGE ORDER NO.
Project Name:
Contract Date:
Contract No.:
Project Number:
Date of Issuance:
Contractor:
Contractor is hereby authorized to make the following changes to the Work under the referenced contract:
(1)
(2)
(3)
(4)
Item
Description of Changes-Quantities, Units,
Price
Price
No.
Unit Prices, Change in Completion Schedule, Etc.
Decrease
Increase
Change in contract price due to Change Order
Total Decrease
$0.00
Total Increase
$0.00
Difference Between Column (3) and (4)
Net Change to Contract Price
Contract Time extension:
The sum of
calendar days; revised completion date:
hereby DOES NOT CHANGE
the current contract price of
making the total adjusted contract price
Office of the General Counsel
Change Order Form - FM
OGC-S-2011-16 (Revised 08.31.2015)
.
Page 1 of 2
It is mutually agreed that the dollar amount and time extension (if any) set forth in this Change Order
constitutes full compensation for all costs, expenses and damages to the Contractor, whether direct,
consequential or otherwise, in anyway incident to, or arising out of or resulting directly or indirectly; from
the Work performed or modified by the Contractor under this Change Order No.
.
ACCEPTED BY:
Contractor
By:
Title:
Date
RECOMMENDED BY:
Architect
By:
Title:
Date
Date
Facilities Management
APPROVED BY:
Date
Date
Date
Date
Date
Office of the General Counsel
Change Order Form - FM
OGC-S-2011-16; Modified 08.31.2015
Page 2 of 2
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