Project Change Order Request Form
Request Date
*
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Month
-
Day
Year
Date
Customer Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job Number
*
If you are a customer filling this out please use the assigned job number listed on your prime contract estimate or deposit Invoice. It will be a 5 digit number. If you can not find the number, just type the last two digits of the year and add XXX, example 23XXX
Change Order Number
To be assigned by Newma field or office staff for tracking purposes. Leave blank if you do not know. Three digits, 001 - 999,
CCDC Contract Number, if applicable
Applicable for projects over $75,000
Location of change order, Plan page ID with date or room/floor/general location
*
A brief disruption of location of work to be completed.
How urgent is this request?
*
Low, can be delt with with within 10 business days
Medium, can be delt within 2 - 5 business days
High, has to be felt with within 48 hours
Newma Project Manager or Site Foreman, change order communicated to
*
First Name
Last Name
Engineer
First Name
Last Name
Change Order Pictures, Plans, Specifications
Browse Files
Drag and drop files here
Choose a file
Please Share pictures, drawings and general files here
Cancel
of
Equipment Specifications and Additional Documents
Browse Files
Drag and drop files here
Choose a file
If you have equipment specifications please upload files here
Cancel
of
Change Order Description
The more information we can capture below will enable us to accurately evaluate the overall impact of this change order and allow us to deliver a more accurate estimate of this change order.
Detailed request of changes, additions and subtractions
*
Please give an accurate description of what this change is in regards too.
Change order reason
*
A very brief reason for this change request, so we can get a clearer picture, so we can ensure we can meet your overall objectives.
Risk Management, see not below
*
Are there safety, delay of schedule, financial or budgetary concern, please articulate it here.
Specifications, brief instruction if not uploaded
Please note color, brand, style, lighting temp and other fine details that must be met, here
Approval
By signing below, you acknowledge that there may be additional costs and changes to the schedule associated to your project.
Owner or Contractor, or either of their representatives submitting this change order request, signature's name
*
First Name
Last Name
Signature, by signing you acknowledge that there may be additional costs and associated to your project
*
Questions?
If you have any concerns or questions please note them here
Submit
Submit
Should be Empty: