Potential Change Order

POTENTIAL CHANGE ORDER Date: Budget Status: Awarded Project:

PCO #:

PCO Title: From:

To:

Contractor

Change Order Scope

Value

Subcontractor Name

Schedule will be increased by:

Subtotal $

-

Overhead / Fee $ Total $

-

0 Days

Agreement: I / we hereby agree to the modifications of the contract as described above and agree to the furnishing of all materials and labor and the performing of all work in connection therewith for the following considerations: ( increase ) the contract amount by the sum of:

$0

Please sign and return this sheet as authorization to proceed with the aforementioned work. Signing this sheet properly authorizes a change in contract value and schedule duration (if required.) A formal Owner Contract Change Order will be forwarded for proper contract revisions.

Owner:

Date: Date