Form No. 0/3 10U
Dwg. No.
HOLMES & NARVER
Order No.
Type F.S. No.
Date:
Title:
Location
INCORPORATED
CHANGE ORDER
~Kind
Job No.
Sheet No.
Detailed
of Change
Reason for
Contract No.
Project No.
Description of Change
of
“Authority
for Change
TENTATIVE COST ESTIMATE AT JOBSITE...
change:
Affects Dwg. Nos.
Proposed By:
Date:
Recommended By:
Date:
Approved By:
Resident Manager, H & N
Date:
Approved By:
Resident Engineer, AEC
Date:
REIMBURSEMENT AUTHORITY
Approval of the above change in work or services, by the undersigned, constitutes reimbursement authority, covering the cost incurred in the performance of the work, as revised.
Any change in the scope or character of the work necessitating adjustment
of the total estimated contractual cost, and/or an adjustment of the Con-
tractor's fixed-fee, will be authorized subsequently, by formal modification to the contract, in accordance with the provisions of Article XIII,
Contract AT-(29-1) -507.
Approved By:
Contract Administrator
Date:
Approved By:
Contracting Officer
Date:
Remarks:
DISTRIBUTION
A. BE. C.
Los Angeles
.
2
3
Engineering Div. Orig & 1
Fiscal
3
Construction Mgr.
Service Operations
Const. Off.
Insp. Off.
6
1
1
1
-
Cost Code
L1-45