Revised 03/02/2017
Form 4CO - Change Order for Construction
CAPITAL IMPROVEMENTS
Subrecipient:
Project Contact:
Contact Phone Number:
Fax:
Project Number:
Change Order No:
Contractor Name:
Project Description:
The construction contract dated between the Subrecipient and Contractor have requested the
following changes are ordered by the engineer and approved by the Subrecipient to become part of the
construction contract.
Reason and description for Change Order – must be specific:
Extension of the Contract Completion date from ________________ to ____________________
1.
$
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
8.
$
9.
$
10.
$
Original Contract:
$
Other Change Orders:
$
Total amount of
this Orders:
$
Net Contract:
$
APPROVAL SIGNATURE(S)
DATE(S)
Subrecipient:
Contractor:
Cook County:
Planner/Inspector:
