CONTRACT CHANGE
ORDER
Contractors, applicant/borrowers, or architect/engineers may complete this
form. Rural Development (RD) provides this form to make changes to a
construction contract. All parties must sign the form including RD�s local
official approving the change order.
Features for transmitting the form electronically are
available to those customers with access credentials only. If you would
like to establish online access credentials with USDA, follow the instructions
provided at the USDA eForms web site.
Contractors,
applicant/borrowers or architect/engineers must complete all of the items
specified in the following table.
|
Fld Name / |
Instruction |
|
1 Order No |
Enter the contract change order number (e.g.; 1,2,3, etc.). |
|
2 Date |
Enter the date this form is completed. |
|
3 State |
Enter the State in which the contract exists. |
|
4 Contract for |
Enter general description of work to be performed. |
|
5 County |
Enter the County in which the contract exists. |
|
6 Owner |
Enter the name(s) of the applicant(s)/borrower(s) who is the property owner. |
|
7 To |
Enter the contractor�s name or company name. |
|
8 Description of Changes |
Enter description of changes to the contract. |
|
9 Decrease in Contract Price |
Enter decrease in dollar amount if contract price is going down. |
|
10 Increase in Contract Price |
Enter increase in dollar amount if contract price is going up. |
|
11 Decrease Totals |
Enter total of decrease dollars. |
|
12 Increase Totals |
Enter total of increase dollars. |
|
13 Net Change Decrease |
Enter the dollar amount of the net change in contract price if the net change is a decrease. |
|
14 Net Change Increase |
Enter the dollar amount of the net change in contract price if the net change is an increase. |
|
15 Justification |
Enter the reason(s) for changes in contract. |
|
16 Sum of |
Enter the dollar amount in written and number format the contract will be increased or decreased by. |
|
17 Contract Total |
Enter the total dollar amount in written and number format the contract will be with the changes in place. |
|
18 Contract Period |
Enter the number of days that the contract time period will increase or decrease by or if it will stay the same. |
|
19 Requested |
Enter signature of the applicant(s)/borrower(s). |
|
20 Date |
Enter the date this form is signed by applicant(s)/borrower(s). |
|
21 Recommend |
Enter signature of the Architect/Engineer if applicable. |
|
22 Date |
Enter the date this form is signed by the Architect/Engineer if applicable. |
|
23 Accepted |
Enter signature of the Contractor/Builder. |
|
24 Date |
Enter the date this form is signed by the Contractor/Builder. |
|
25 Approved by Agency |
Enter signature and title of the RD Approval Official. |
|
26 Date |
Enter the date this form is signed by the RD Approval Official. |