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Community Services Department
CONTRACT CHANGE ORDER AGREEMENT
(ϳͬϬϳͬϮϬϮϱ)CONTRACT:CAG
CONTRACTOR:
CHANGE ORDER:(CO#ϭ)
SUMMARY OF PROPOSED CHANGE:Reason/Justification:dŚĞŽƌŝŐŝŶĂůĐŽŶƚƌĂĐƚǁĂƐƚŽďĞ
ĐŽŵƉůĞƚĞĚďLJ:ƵůLJϰ͕ϮϬϮϱ͘ĚĚŝƚŝŽŶĂůƚŝŵĞŝƐďĞŝŶŐĂĚĚĞĚƚŽƚŚĞĐŽŶƚƌĂĐƚĚƵĞƚŽĐŽŶƚƌĂĐƚŽƌƐůĂƚĞ
ƉĞƌĨŽƌŵĂŶĐĞ͘dŚĞĐŽŶƚƌĂĐƚǁŝůůďĞĞdžƚĞŶĚĞĚƐŽƚŚĂƚǁŽƌŬƐŚĂůůďĞĐŽŵƉůĞƚĞĚďLJ&ƌŝĚĂLJϴͬϭϱͬϮϬϮϱ͘
DESCRIPTION:
Item Qty. Description Unit Price Amount
No.w/ WSST
Total this Change Order: -$
ORIGINAL CONTRACT CURRENT CONTRACT NET CHANGE REVISED CONTRACT
AMOUNT (W/ WSST) AMOUNT THIS ORDER (W/ WSST) TOTAL AFTER CHANGE
Additional Calendar Days:
(0) džƚĞŶƐŝŽŶŽĨƚŝŵĞƌĞƋƵĞƐƚĞĚ. Completion Date is ϴͬϭϱͬϮϬϮϱ .
SIGNATURES:
Contractor:Date:
Project Manager:Date
Approved By:Date:
(name of approver)
The payment specified and agreed to in this change order includes every claim by the contractor for any
extra payment with respect to the work described in this change order. The work covered by this change
order must be performed under the same terms and conditions as that included in the original
agreement. All of the other terms of the original agreement remain in effect.
-$$-
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