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[]
["Please use this form to track change order cost throughout the construction phase "]
["Contractor:"]
["Project Name:","ABC Project "]
["Project No:","XX###"]
["Prepared by:"]
[]
[{"$nulls":7},"Date:"]
[]
[null,null,"Contract #:","12-123-1-ITB"]
[null,null,"Purchase Order #:","PO# 123456"]
[{"$nulls":3},"Fund","Natural Acc.","Cost Center","Project","Source of Fund","Task"]
[null,null,"Account Number to Increase PO:",123,123456,12345,"0000","0000","0000"]
[]
[]
[]
[]
["TOTAL CONTRACT AUTHORIZATION",null,{"v":1100000,"d":"$1,100,000.00"}]
["(PO and Contingency)"]
[]
["ORIGINAL PURCHASE ORDER AMOUNT:",null,{"v":100000,"d":"$100,000.00"}]
["(Contract without Contingency)"]
[]
["CONTRACT CONTINGENCY AMOUNT:",null,{"v":10000,"d":"$10,000.00"}]
[]
["TOTAL CHANGE ORDERS INCREASE:",null,{"v":1000,"d":"$1,000.00"}]
[]
["Change #","Amount","Description",{"$nulls":5},"Date"]
["CO # 1 ",{"v":1,"d":"$1.00"}]
["CO # 2",{"v":1,"d":"$1.00"}]
["CO # 3",{"v":1,"d":"$1.00"}]
["CO # 4",{"v":1,"d":"$1.00"}]
["CO # 5",{"v":1,"d":"$1.00"}]
["CO # 6"]
["CO # 7"]
["CO # 8"]
["CO # 9"]
["CO # 10"]
["CO # 11"]
["CO # 12"]
["CO # 13"]
["CO # 14"]
["CO # 15"]
["CO # 16"]
["CO # 17"]
["CO # 18"]
["CO # 19"]
["CO # 20"]
["CO # 21"]
[]
[]
["AUTHORIZED CONTINGENCY BALANCE:",null,{"$f":"C24-C26","v":{"v":9000,"d":"$9,000.00"}}]

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["ITB #: ",null,"PURCHASE ORDER #:                                                          ",null,{"$f":"'CHANGE ORDER BUDGET SUMMARY'!$D$11","v":"PO# 123456"},null,"CHANGE ORDER #:"]
[]
["PROJECT NAME :",null,{"$f":"'CHANGE ORDER BUDGET SUMMARY'!$B$4","v":"ABC Project "}]
[]
["PROJECT NO :",null,{"$f":"'CHANGE ORDER BUDGET SUMMARY'!$B$5","v":"XX###"}]
[]
["LOCATION AND DESCRIPTION OF PROPOSED WORK                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        "]
["SEE CHANGE ORDER JUSTIFICATION MEMO "]
["EXPLANATION OF NECESSITY FOR PROPOSED WORK                                                                                                                                                                                                                 "]
["SEE CHANGE ORDER JUSTIFICATION MEMO "]
["A time extension of",null,null,"calendar days will be allowed for this work."]
["New completion date:                                            "]
["Amount of original contract:                 ",{"$nulls":3},"Total of other C.O. (s): "]
["New contract amount:                 ",null,null,{"$f":"D13+H13+I25","v":{"v":18,"d":"$18.00"}}]
[]
["ESTIMATE OF PROPOSED WORK"]
["SPEC NO.","LOCATION","ITEM",null,null,"QUANTITY","UNIT","UNIT PRICE","INCREASE","DECREASE"]
[{"$nulls":7},{"v":10,"d":"$10.00"},{"$f":"IF($H18>0,$H18,\"-\")","v":{"v":10,"d":"$10.00"}},{"$f":"IF($H18<0,$H18,\"-\")","v":"-"}]
[{"$nulls":7},{"v":-1,"d":"$(1.00)"},{"$f":"IF($H19>0,$H19,\"-\")","v":"-"},{"$f":"IF($H19<0,$H19,\"-\")","v":{"v":-1,"d":"$(1.00)"}}]
[{"$nulls":7},{"v":2,"d":"$2.00"},{"v":2,"d":"$2.00"},"-"]
[{"$nulls":7},{"v":-2,"d":"$(2.00)"},"-",{"v":-2,"d":"$(2.00)"}]
[{"$nulls":7},{"v":-1,"d":"$(1.00)"},"-",{"v":-1,"d":"$(1.00)"}]
[{"$nulls":7},{"v":10,"d":"$10.00"},{"v":10,"d":"$10.00"},"-"]
[{"$nulls":5},"Total ",null,null,{"$f":"SUM(I18:I23)","v":{"v":22,"d":"$22.00"}},{"$f":"SUM(J18:J23)","v":{"v":-4,"d":"$(4.00)"}}]
[{"$nulls":5},"Net Increase/Decrease",null,null,{"$f":"SUM(I24:J24)","v":{"v":18,"d":"$18.00"}}]
["I/We hereby agree to perform and/or nonperform as indicated, the work described herein and at the unit prices set forth and that such work shall be performed in accordance with the Contract provisions and specifications and/or other provisions incorporated herein.  Further, I/we hereby agree that the quantities set forth herein will be applicable to the adjusted quantities, including overruns up to twenty-five percent of the quantities shown herein. The Contractor's signature is its agreement that the adjustments in Contract price and/or Contract Time stipulated in this Change Order constitute full, complete and final compensation for all costs and time associated with this Change Order. The Contractor agrees that this Change Order represents an all-inclusive and equitable adjustment to the Contract, and further agrees to waive all rights to make  further claims arising out of or as a result of this change. Except as hereby specifically modified, all terms and conditions of the Contract as heretofore modified remain unchanged and in full force and effect."]
["CONTRACTOR:                                                                                                                       ",{"$nulls":4},"BY"]
[null,"                                                 FIRM'S NAME                                         ",{"$nulls":4},"OFFICER OF THE FIRM",null,null,"DATE"]
["                                                                                                              "]
["PROJECT OFFICER (CONSTRUCTION MANAGER)",{"$nulls":3},"DATE"]
[]
["DESIGN TEAM SUPERVISOR (DETS)",{"$nulls":3},"DATE"]
[]
["CONSTRUCTION MANAGEMENT SUPERVISOR (CMS)",{"$nulls":3},"DATE"]
[]
["ENGINEERING BUREAU DIVISION CHIEF (EBC)",{"$nulls":3},"DATE"]