Contractor (Name and Address):

Contemplated Change No.:

Contract No.:

Project No.:

Description and Location of Project:

It is proposed to make the following change in the work. You are requested to quote a firm price for any revision to the contract amount arising from this change. No work should be undertaken on this change until a change order/written authorization has been signed and issued.

Quotation to be submitted within days of the date of this notice.

Description of Change:

The work shall conform to the contract documents where applicable unless otherwise stated.

Departmental Representative: _________________________________

Date (YYYY-MM-DD):

Contractor (Name and Address) 2:

Contemplated Change No. 2:

Contract No. 2:

Project No. 2:

Estimate:

Description and Location of Project 2:

Reasons for Change:

Category:

THIS PAGE IS NOT TO BE DISTRIBUTED TO THE CONTRACTOR

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