Change order request
Price a change, document why it happened, and get it signed before the work is billed.
os.construction
Free template
Free template
Project
Job #
CO request #
Date submitted
To (owner / architect)
From (contractor)
Related RFI / ASI / change event
Response needed by
1 · Description of change
Scope added, deleted or changed. Reference drawings and spec sections.
2 · Reason for change
Owner requestDesign change / ASIHidden or unforeseen conditionRFI responseCode / AHJ requirementAllowance reconciliationOther
Supporting documents attached
RFI and responseRevised drawings / sketchSub and supplier quotesT&M ticketsPhotosSchedule fragnet
3 · Cost breakdown
| Cost element | Basis / notes | Amount |
|---|---|---|
| Labor (self-performed, incl. burden) | ||
| Material | ||
| Equipment | ||
| Subcontract (attach quote) | ||
| Subtotal: cost of the work | ||
| Overhead and profit ( ____ % per contract) | ||
| Subcontractor markup ( ____ % per contract) | ||
| Insurance and bond ( ____ %) | ||
| Total requested change to contract sum |
Illustrative example (Riverside Medical Center sample job, CO #14, fire dampers from RFI-212): subcontract $68,000 (Summit Mechanical CCO-03) + supervision labor $6,500 + firestopping material $3,600 = cost $78,100. Fee and sub markup $6,014 + insurance and bond $2,286 = markup $8,300. Total requested $86,400.
4 · Schedule impact
No change to contract timeExtension requested
Calendar days requested
Revised completion date
Activities affected
Float consumed (days)
5 · Approval
Approved as submittedApproved as notedRevise and resubmitRejected
Notes / conditions
ContractorSignatureName, title, date
Architect / engineerSignatureName, title, date
OwnerSignatureName, title, date
Not a replacement for AIA G701 or your contract's change order form. Use it to price and document the request; follow the notice periods and markup limits in your contract. Do not bill the work until the change order is executed.
Template from os.construction/resources/templates. Free to use and adapt.Requirements vary by contract and state. Your contract documents govern.