Subcontract Change Order/overrun Authorization Form printable pdf download

CITY OF NEW YORK

DEPARTMENT OF DESIGN AND CONSTRUCTION

DIVISION OF STRUCTURES

SUBCONTRACT CHANGE ORDER/OVERRUN AUTHORIZATION

(For CM Build/CM Design Build contracts only)

PART A

_____________________________________________

DDC PROJECT MANAGER’S PROGRAM UNIT:

DDC PROJECT MANAGER’S NAME:

PROJECT NAME:

PROJECT DESCRIPTION:

PROJECT BOROUGH: [ ] M [ ] Q [ ] SI [ ] BX [ ] BK [ ] Multi [ ] Other. Please explain _______________________

FACILITY (if applicable):

SUBCONTRACTOR (Name & Address):

SUBCONTRACTOR TRADE OR SERVICE:

CM BUILDER/CM DESIGN BUILDER (Name & Address):

CONTRACT REG. NO. ____________ FMS ID ___________ Task Order No.* _______ Sub. C.O./O.R. No.________

CONTRACT TITLE:

__________________________________________________________________________________________

SECTION I - PROPOSED CHANGE

Description of Change

Note: All work shall be performed in accordance with the terms, stipulations and conditions of the original Subcontract Documents

CHANGE ORDER/OVERRUN CLASSIFICATION

[ ] Non-Material scope change [ ] Field Condition [ ] Administrative change [ ] Design Error [ ] Design Omission

[ ] Other

Is this a client agency request? [ ] Yes [ ] No

__________________________________________________________________________________

SECTION II-CM BUILDER/CM DESIGN BUILDER REVIEW AND RECOMMENDATION

)

(Completed by CM Builder/CM Design Builder

The subcontractor’s proposed cost for this change is $__________________. We have reviewed the proposed change indicated above.

Based on our review and analysis, we recommend owner approval of this change in the amount of $___________________. Attached are

copies of the following supporting documents:

[ ] Subcontractor’s Cost Proposal [ ] CM Builder/CM Design Builder’s Independent Cost Estimate [ ] Notarized Cost Pricing Certificate

[ ] Bids (if applicable)

[ ] Copies of specs and/or drawings that relate to the change order condition [ ] Emergency Letter and/or Client

Request Letter [ ] Other (Indicate) __________________________________________________________________________

Note: CM shall provide copies of all Notice of Award Letters for Subcontractor Agreements to DDC Project Manager, EAO and ACCO.

___________________________________________

_______________________________________

__________________

(Print CM Builder/CM Design Builder’s name and title)

(Signature)

(Date)

______________________________________________________________________________________________

SECTION III -DDC REVIEW AND RECOMMENDATION (DDC EMPLOYEE ONLY)

Reviewed By:

__________________________________

______________________________

__________

_________________________

Print Name**)

(Signature)

(Date)

(Recommended Approval Amt.)

* For CM Build Requirements Contracts.

** If = or < $50,000: Project Manager; if > $50,000: Program Director; if Program Unit or Triad Requirements Contract: Triad A/C; if

Division-wide Requirements Contract: First A/C.

Note: After completing Section III, submit to the EAO Director for all recommended amounts > $25,000, and for all credit and no

cost amounts: item numbers 1-7 listed in Step 1 of the “PM Steps for Subcontract Change Order Authorizations”.

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09/01/98; rev. 03/15/01

Subcontract Change Order/overrun Authorization Form

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