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CONTRACTOR CHANGE ORDER REQUEST SUMMARY

Project Name: C.O.R. NO:

Project NO: Date:
Contractor:

Description of Change:

Prime Contractor Direct Costs

Additive Costs
A Labor 9000
B Material 15000
C Equipment 30000

D Subtotal of Additive Cost 54000

Deductive Costs (Use parenthesis to denote negative figures)

E Labor -4000
F Material -3000
G Equipment -10000

H Subtotal of Deductive Cost -17000

I Contractor's Total Direct Cost (D+H) 37000

J General Contractor's Mark-up 5000

K Total Prime Contractor Direct Costs + Mark-up (Line I + J) 42000

L Total Subcontractor Direct Costs 33000

M Subcontractor Mark-up 5000

N General Contractor's Mark-up on Subcontractor Direct Costs 3000

O Total General Contractor Change Request (Lines K + L + M + N) 83000

To the best of my knowledge and belief, I certify that all costs listed abve are correct.

Contractor Signature Date