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CHECK LIST FOR CHANGE ORDERS (To be sent with the Draft Change Order to the District Engineer)

Enter complete Job Name as shown on contract.

Enter only FAP Number(s) involved in change, or FAP Number and Non-Participating, as applicable.

A summary of quantities and money value per each FAP if more than one FAP Number or Non-Participating is involved.

Describe all changes fully.

What is being changed, added or deleted?

What is the location of change or changes? (Station Number, distance left or right of centerline.)

What is the contract description (exact wording) of the Item or Items?

Sketches.

Include Job Number, FAP Numbers and Change Order Number.

If applicable, include: Existing and proposed details. Station numbers and dimensions. Plan view and Elevation view. Quantities and descriptions.

NOTE: If possible, make sketches on 8-1/2 x 11” sheets, suitable for reproduction.

Reason for Change: What necessitated this change? Were other alternates considered? Was cost analysis made of other alternates? Are they attached? What would happen if this change is not made? Items should appear in the order as listed in the contract.

Item Number, description, unit and unit prices for existing items should be identical to those shown in the contract.

FIGURE 104-4

7-01-03

Page 100-20

CHECK LIST FOR CHANGE ORDERS (continued)

Supplemental Agreement Items: List Items last under summary.

Include the following note on the face of the change:

“NOTE: UNIT PRICE(S) FOR

[name of item(s)]

HAS/HAVE BEEN

AGREED TO AND WILL BE ESTABLISHED BY SUPPLEMENTAL AGREEMENT.” NOTE: Name of Items should be the exact wording as shown in summary.

Include a Special Provision if new item is not included in the Standard Specifications.

Check with the Construction Office to determine whether a Supplemental Specification is required.

Do not show total plan quantity in “Present Quantity” column unless revision is for entire job.

Change should reflect quantities involved within limits designated.

CHECK ARITHMETIC! Right-of-Way Acquisition.

When acquisition of additional right-of-way or construction easement is involved, change order submitted will bear the notation: “APPROVAL OF THIS CHANGE ORDER IS CONTINGENT ON THE ACQUISITION OF ADDITIONAL RIGHT-OF-WAY/CONSTRUCTION EASEMENT.”

Attach sketch showing Job Number, FAP Number, Change Order Number, location, dimensions and areas of additional R/W or Easement to be acquired.

On Change Orders where additional time is allowed to complete the change order work, full justification should be shown for the number of days added. An analysis of time and a letter of concurrence from the contractor should be attached to the proposed change order if contract time is extended. [See 108.06 of Standard Specifications and subsection 104.03(a) of this manual.]

Be sure the Job Number, Change Order Number, FAP Number, and County are shown on ALL documents accompanying or attached to the Change Order.

Check to determine whether this is a District Engineer Authorized Change Order (under $50,000) or an Assistant Chief Engineer Authorized Change Order.

If a District Engineer authorized Change Order, do ALL pertinent Divisions concur with the Proposed Change Order?

USE THE CORRECT CHANGE ORDER FORM!

FIGURE 104-4(CTD)

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