CHANGE ORDER REQUEST FORM
Sample Cover Letter
NOTE: A cover letter should be generated on your company’s letterhead.
January 31, 2015
Mr. John Brown, PE/S Greenfield District Office
Indiana Department of Transportation
32 South Broadway
Greenfield, IN 46140-7751
RE: INDOT Contract No. R-12345A, Overtree Avenue Rehabilitation
Change Order Request No. 1: Additional Drive Approach, Line T, Sta. 100+00
Dear Mr. Brown:
Please consider this letter as a formal change request notice. Per your request, we
submit the enclosed Change Order Request form and associated supporting
On Monday, January 26, you provided a written request for us to furnish change order
pricing for adding a new 6 IN. PCCP drive approach and associated items at Line T,
Sta. 100+00, left. Enclosed is a Change Order Request Form, which includes the
change order details, associated costs and a schedule revision.
The current schedule revision included in this change order request is dependent upon
receipt of a written approval by the close of business day, February 16, 2015.
Thank you for consideration of this request. If you need clarification or additional
information, please contact me at (555) 555-5555.
David Green, P.M.