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Kelowna - Victoria, British Columbia, Canada. ,

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Change Order

Service Agreement / Change Order 

Change Order relating to a contract between a Contractor and a Principal whereby the two parties agree to a change in the original contract. This particular form includes a provision for an additional charge for the requested change.

Change Order

Contractor (Name and Address):


___________________________________________________________________________________________  


Change Order No.:___________________________________________


Contract No.:_______________________________________________


Project No.:________________________________________________


Description and Location of Work:_________________________________________________________________________________________


____________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________


Original Amount of Contract:__________________________________


Approved C.O. Amount to Date:_______________________________


Present C.O. Amount:_______________________________________($0.00)


Revised Contract Amount:___________________________________($0.00)


Description of Change 1
_______________________________________________________________________Total_________________________________________
Description of Change 2
_______________________________________________________________________Total_________________________________________Description of Change 3
_______________________________________________________________________Total_________________________________________Description of Change 4
_______________________________________________________________________Total_________________________________________Description of Change 5
_______________________________________________________________________Total_________________________________________Description of Change 6
_______________________________________________________________________Total_________________________________________Description of Change 7
_______________________________________________________________________Total_________________________________________Description of Change 8
_______________________________________________________________________Total_________________________________________Description of Change 9
_______________________________________________________________________Total_________________________________________Description of Change 10
_______________________________________________________________________Total_________________________________________Description of Change 11
_______________________________________________________________________Total_________________________________________Description of Change 12
_______________________________________________________________________Total_________________________________________Description of Change 13
_______________________________________________________________________Total_________________________________________Description of Change 14
_______________________________________________________________________Total_________________________________________Description of Change 15
_______________________________________________________________________Total_________________________________________Description of Change 16
_______________________________________________________________________Total_________________________________________Description of Change 17
_______________________________________________________________________Total_________________________________________

Description of Change1 -17_total   
                                                                                                                                              Total:_______________________________


Recommended: _______________________________________


Signature: ___________________________________________


Date (YYYY-MM-DD):__________________________________


2nd Signature (if applicable): ___________________________________________


Date (YYYY-MM-DD)2:_________________________________


Approved:___________________________________________


Signature: ___________________________________________


Date (YYYY-MM-DD)3:_________________________________


Contractor (Name and Address)2: _______________________________________


Change Order No.2:___________________________________________________


Contract No.2:_______________________________________________________


Project No.2:________________________________________________________


Description and Location of Work 2:_______________________________________________________________________________________


____________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________


Reasons for Change:___________________________________________________________________________________________________


____________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________


Category:

Select one or more values

AC Client requested changes to OGD funded projects ______________

AD Dominion or Regional Fire Commissioner required changes________________

AF Facilities Maintenance requested changes to PWGSC ______________

AP Property Management requested changes to PWGSC________________

AR Regulatory Agencies, other than DFC/RFC, required changes to conform to codes and statutes________________

BD Delay or negligence on the part of the Crown resulting in a claim from the Contractor______________

BS Soil conditions different from those specified_____________

BT Federal Tax, duty or tariff changes during the contract period_____________

BU Unit price changes due to quantities, and Balancing Change Orders_____________

CE/O Design Errors or Omissions costs, items that could or should have reasonably been foreseen_____________

CM Material Substitution initiated by Crown or Contractor_____________

CS Site condition costs resulting from items that could not have reasonably been foreseen_____________

CT Acceleration or deferment of part of the work requested by the Crown (not a time extension or delay claim initiated by the Contractor)___________

A Client requested changes_____________

B Errors and omissions_____________

C Unforeseen site conditions_____________

D Substitution of materials_____________

E Price and quantity fluctuations____________

F Delays, acceleration, suspension_____________

G Other____________

L Inducement (Lease)___________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Pursuant to section 32(1) of the Financial Administration Act, funds are available.


Signature (Mandatory): ___________________________________________


Date (YYYY-MM-DD)4:___________________________________________


http://www.tpsgc-pwgsc.gc.ca/app-acq/forms/610-eng.html