CHANGE ORDER REQUEST

(Proposal for Change)

REQUEST INFORMATION

PROJECT INFORMATION

PARTIES

REQUEST ORIGINATED BY

☐ Owner
☐ Contractor
☐ Architect/Engineer
☐ Subcontractor: [Name]
☐ Other: [___]

1. DESCRIPTION OF PROPOSED CHANGE

1.1 Summary

[Brief one-sentence summary of the change]

1.2 Detailed Description

[Provide detailed description of the proposed change, including:
- Specific work to be added, deleted, or modified
- Location within the project
- Technical specifications or requirements
- Any special conditions or constraints]

1.3 Reason for Change

☐ Owner Request / Design Preference
☐ Unforeseen Site Condition
☐ Design Error or Omission
☐ Code Requirement / Regulatory
☐ Coordination Issue
☐ Value Engineering
☐ Material Unavailability / Substitution
☐ Other: [___]

Explanation:
[Explain the reason/necessity for the change]

2. REFERENCE DOCUMENTS

3. SCOPE OF WORK

3.1 Work to be Added

3.2 Work to be Deleted

3.3 Work to be Modified

4. PROPOSED COST

4.1 Cost Breakdown

LABOR:

MATERIALS:

EQUIPMENT:

SUBCONTRACTOR(S):

4.2 Cost Summary

4.3 Credits (If Applicable)

4.4 Net Cost Impact

5. PROPOSED TIME IMPACT

5.1 Schedule Impact

☐ No impact to project schedule
☐ Adds [___] calendar days to project schedule
☐ Reduces project schedule by [___] calendar days
☐ To be determined

5.2 Impact Analysis

Affected Activities:
- [Activity 1] - Impact: [___] days
- [Activity 2] - Impact: [___] days
- [Activity 3] - Impact: [___] days

Critical Path Impact:
☐ On critical path
☐ Not on critical path
☐ Analysis required

Explanation:
[Explain how and why the change impacts the schedule]

5.3 Mitigation (If Applicable)

[Describe any measures to minimize schedule impact]

6. SUPPORTING DOCUMENTATION

The following documents are attached:

☐ Detailed Cost Estimate
☐ Subcontractor Quote(s)
☐ Material Quote(s)
☐ Labor Hour Calculation
☐ Revised Drawings/Sketches
☐ Photographs
☐ Manufacturer Data
☐ Schedule Analysis/Fragnet
☐ Specification Reference
☐ Other: [___]

7. ALTERNATIVES CONSIDERED

Alternative 1: [Description]

• Cost: $[___]
• Time: [___] days
• Pros: [___]
• Cons: [___]

Alternative 2: [Description]

• Cost: $[___]
• Time: [___] days
• Pros: [___]
• Cons: [___]

Recommendation: [Which alternative and why]

8. IMPACT IF NOT APPROVED

[Describe the consequences if this change is not approved, including:
- Impact on project functionality
- Code compliance issues
- Safety concerns
- Schedule delays
- Other impacts]

9. WORK STATUS

☐ Work has NOT started - awaiting approval
☐ Work is in progress under Construction Change Directive
☐ Work has been completed - documentation/approval pending

10. CONTRACTOR'S CERTIFICATION

By submitting this Change Order Request, Contractor certifies that:

1. The proposed pricing is accurate and based on actual costs
2. All subcontractor and material costs have been verified
3. The time impact analysis is based on current project schedule
4. This request does not include any costs already covered under the Contract
5. Supporting documentation is accurate and complete

SUBMITTED BY:

11. REVIEW AND DISPOSITION

Architect/Engineer Review

Comments:
[___]

Recommended Cost: $[___]
Recommended Time: [___] days

Owner Disposition

☐ APPROVED - Proceed with Change Order preparation
☐ APPROVED WITH MODIFICATIONS - See comments
☐ REJECTED - See comments
☐ PENDING - Additional information required
☐ DEFERRED - Hold for future decision

Approved Amount: $[___]
Approved Time: [___] days

Comments:
[___]

DISTRIBUTION

☐ Owner
☐ Architect/Engineer
☐ Contractor
☐ Project File
☐ Subcontractor(s): [Names]

COR TRACKING LOG

Status Codes: P = Pending, A = Approved, R = Rejected, D = Deferred, W = Withdrawn

[// GUIDANCE:
1. Submit COR promptly when change is identified
2. Do not proceed with changed work until approved (unless directed)
3. Provide complete supporting documentation
4. Maintain COR log throughout project
5. Track COR through approval process
6. Convert approved CORs to formal Change Orders]