POTENTIAL CHANGE ORDER

Date:
Budget Status: Awarded
Project: PCO #:

PCO Title:

From: To:

Contractor Change Order Scope Value

Subcontractor
Name

Subtotal $ -
Overhead / Fee $ -
Total $ -

Schedule will be increased by: 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