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Oders 1

The Change Order Request Form is designed for documenting changes in a project, including details about the project, client, and contractor. It requires a description of the change, reasons for the change, and impacts on cost and schedule. The form also includes sections for authorization by both the contractor and client.

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floorcodezim
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25 views2 pages

Oders 1

The Change Order Request Form is designed for documenting changes in a project, including details about the project, client, and contractor. It requires a description of the change, reasons for the change, and impacts on cost and schedule. The form also includes sections for authorization by both the contractor and client.

Uploaded by

floorcodezim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CHANGE ORDER REQUEST FORM

Project Name: _______________________________


Project Address: _____________________________
Client Name: _________________________________
Contractor Name: _____________________________
Original Contract Number: ____________________
Date of Original Contract: ____________________
Change Order Number: ________________________
Date of Request: _____________________________

Description of Change

Provide a detailed explanation of the change being requested (e.g., additional work, material
substitution, design modifications, etc.)

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Reason for Change

Explain why this change is necessary (e.g., client request, unforeseen site conditions, design
error/omission, etc.)

________________________________________________________________________
________________________________________________________________________

Impact on Cost

Item Description Qty Unit Cost (USD) Total Cost (USD)


Total Additional Cost USD ___________

Impact on Schedule

Indicate whether the change affects the project timeline.

 ☐ No impact on schedule
 ☐ Revised completion date: [Insert New Date]
 ☐ Estimated delay: [Insert Number] days
Authorization

By signing below, both parties acknowledge and agree to the change(s) as described above,
including any cost and time adjustments.

Requested by (Contractor):
Name: ____________________________
Signature: _________________________
Date: _____________________________

Approved by (Client):
Name: ____________________________
Signature: _________________________
Date: _____________________________

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