CHANGE REQUEST (FORM C-00 63 60)
(Design Changes/Deviations/Substitutions)
CR NO.
DATE
Project:
Request Initiated by: Impact to Contract Price expected []
LC] Contractor Impact to Contract Time expected []
C] Owner Change Orders will be processed separately
C] Engineer
Request submitted as (format):
Description of Change (L_] documentation attached)
Reason for Change
Response: [_] This constitutes a Written Amendment to the Agreement.
Review of the proposed change/deviation/substitution by Engineer is for general compatibility with the design concept of the Project. This review does not
extend to means, methods, sequences, or procedures of construction or to issues of safety incident thereto. This review shall not relieve the Contractor
from responsibility for full compliance with the requirements specified and to determine and verify the information contained therein.
Recommended By Engineer for Acceptance (Subject to L | Approved by Owner (no schedule or cost impact)
above comments if any) | Acknowledged by Owner — to be processed and approved
C] recommended for processing and approval under a under a separate Change Order
separate Change Order
NAME: NAME:
Signature Date Signature Date
Approved by Contractor
LC] Change Order to be requested
NAME:
Signature Date
