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Change Order Form
Change Order Number: THREE
Project Title Traffic Engineering Ph II
Original Contract Date: 11-17-03
Owner: ARC
Contractor: Beams Contracting. Inc
Date: 03-22-06
Project Number: 323-04-200823591
P.O. Number 81257
The following change order is hereby made to the proposal for the above project:
See Attached
TOTAL AMOUNT OF THIS CHANGE ORDER $ 53.868.00
The Contract time will be increased by ~ additional calendar days as a result of this
change.
Original Contract Amount
Previous Change Order
(Increased / Decreased)
This Change Order
(Increased / Decreased)
TOTAL CONTRACT WITH CHANGE ORDER(S)
,Requested By: Date:
Submitted By: Date:
Finance Endorsement: Date: if- (0-6 (p
Recommended By: Date: L)/p/t ~
Approved By: Date: 't I ~{ (.,(,.
Accepted By: Date: ~/::;3/0c"
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COPIES :'Assistant Director-Engineering
Kakoli Basu, Accountant, Engineering
Geri Sams, Procurement
Pre Construction File
Notes for Purchasing - Please use account # 324041110-5414110 / 202824020-5414110.