CONTRACT

E.W.R. N.___________________
EXTRA WORKS REQUEST
SUPERSEEDED REVISION

PLAN /UNIT 1 2 3

SUBCONTRACTOR Subcotract N.

SCOPE OF WORK

REFERENCES

DESCRIPTION OF WORKS

JUSTIFICATION OF E.W.R.
(Reason why it is issued)

ESTIMATED COST

FINAL PRICE

PROPOSED BY: SUBCONTRACTOR IS REQUESTED TO PREPARE THE SUBCONTRACTOR IS AUTHORIZED TO PROCEED WITH THE WORKS
ESTIMATE
DS (DISCIPLINE SUPERVISOR) STM (SITE MANAGER)_______________________________________________________
DATE
STM (SITE MANAGER)____________________________
______________________________ DATE:
SAM (SUBC. ADM. MANAGER_________________________________________________________
DATE: DATE

SAM (SUBC. ADM. MANAGER)__________________________ PD/PM (PR. DIRECTOR OR PR. MANAGER)_________________________________________

DATE: DATE

REASON FOR EWR (SEE PARA …………………………………………….) FORMS OF PAYMENT

1 CLIENT REQUEST ● MEASURED WORKS

2 REQORK: - DUE TO ENGINEERING ● LUMP SUM

- DUE TO CONSTRUCTION

3 DESIGN REVISION ● REIMBOURSABLE

- HR

4 ADDITIONAL WORKS - U.P.

5 S/C OR VENDOR BACKCHARGE (NAME AND SUBCONTRACT / P.O. NUMBER (_________________________________________________)

6 SUBCONTRACTOR CLAIM

7 NEGATIVE

8 PRECOMMISSIONING/COMMISSIONING

IMPACT ON SCHEDULE YES NO

DISTRIBUTION

√ COST CONTROL √ PROCUREMENT COORDINATOR (ONLY IN CASES OF BACKCHARHES TO VENDORS)

√ SUPERVISOR √ FIELD ENGINEER MANAGER (ONLY FOR REWORK DUE TO ENGINEERING)
√ SUBCONTRACTOR

FIRME

CONFIRMATION OF WORK EXECUTED APPROVAL APPLICABLE ONLY TO REIMBOURSABLE EWR WHEN SUBCONTRACTOR ACCEPTANCE
FINAL COST EXCEED BY MORE THAN 10% THE ESTIMATED COST

DS ___________________________Date__________________ _____________________________ Date_______________

PD/PM ________________________Date__________________

ATTACHMENTS

714572159.xlsx
714572159.xlsx