ABCDEFGHIJKLMNOPQRSTUVWXYZAA
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Insert Your Letterhead Here
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CONTRACTOR CHANGE ORDER REQUEST SUMMARY
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Format Prepard By: Parag Pal Visit: www.civilnotess.com
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Project Name:
Contract Number
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Project Number:
Date:
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 Contractor Name :
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Description of Change:
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Main Contractor Direct Costs
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Additional Costs
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ALabor50000
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BMaterial
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CEquipment
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D
Subtotal of Additional Costs
50000
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Deducted Costs
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ELabor
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FMaterial
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GEquipment
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H
Subtotal of Deducted Costs
0
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Contractor's Total Direct Cost (D+H)
50000
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J
General Contractor's Adjustments
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Total Prime Contractor Direct Costs + Mark-up (Line I + J)
50000
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Total Subcontractor Direct Costs
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Subcontractor Adjustments
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N
General Contractor's Mark-up on Subcontractor Direct Costs
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Total General Contractor Change Request (Lines K + L + M + N)
50000
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To the best of my knowledge and belief, I certify that all costs listed abve are correct and in line with the Construction Requirements.
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Contractor Signature
Date
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