Form 1 "Contract Change Order" - New York City

What Is Form 1?

This is a legal form that was released by the New York City Department of Parks and Recreation - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 17, 2006;
  • The latest edition provided by the New York City Department of Parks and Recreation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 1 by clicking the link below or browse more documents and templates provided by the New York City Department of Parks and Recreation.

ADVERTISEMENT
ADVERTISEMENT

Download Form 1 "Contract Change Order" - New York City

Download PDF

Fill PDF online

Rate (4.5 / 5) 75 votes
CITY OF NEW YORK
Agency
Unit/Div
CONTRACT CHANGE ORDER – Form 1: Contractor Proposal
PROJECT IDENTIFICATION
Contract Title/Description:
Contract Registration No.:
FMS Project ID:
Procurement Identification Number (PIN #):
FMS Project ID Description:
Agency Contract No.:
FMS Occurrence ID:
CONTRACTOR / CONSULTANT INFORMATION
Contractor Name:
Contractor Address:
Contractor Telephone:
Goods/Services Provided by this Contract (e.g., Design, Construction,
If this is a Construction Contract,
CM, etc.):
Name of the Design Consultant:
CHANGE ORDER INFORMATION
Change Order (CO) No.:
or Over/Underrun(OR) No.:
Original Contract Award Amount:
Change Order Title:
: Describe the work to be performed in this Contract Change (use additional pages, if
Change Order Description
necessary)
Check if addtl page(s) is attached
Contract Proposal
Authorized Cost
$
-
$
-
1. Contractor shall not proceed with this work until issued a Contract Change or otherwise directed by the Commissioner. All work begun before Contract Change is
registered by the Comptroller’s Office is done at the Contractor’s own risk.
2. All work is subject to audit by the Department’s Engineering Audit Officer and to post-audit by the Comptroller’s Chief Engineer.
3. All payments for extra work must be requisitioned separately from payments for work required under the original Contract (except at Final Payments).
AUTHORIZED SIGNATURES
CONTRACTOR APPROVAL
AGENCY APPROVAL
Submitted above is my cost proposal for contract change. The
The amount of this contract is approved. Payment will be made in
Contractor certifies that the cost and pricing data submitted are
accordance with the agreement and shall not exceed the final
accurate, complete and current as of this date.
authorized cost. Payment may not be made prior to registration of this
contract change by the Comptroller’s Office.
Contractor Signature:
Authorized Signature:
Name:
Name:
Title:
Date:
Title:
Date:
Telephone No.:
Telephone No.:
Contractor Agrees with Authorized Cost
The Contractor agrees to perform the work described in this contract
change in accordance with the final authorized cost set forth above.
Basis of Payment
Time and Materials
Contractor Signature:
Lump Sum
Name:
Unit Price
Title:
Date:
Cost Plus Fixed Fee
Telephone No.:
Overrun/Underrun
Placeholder for Agency’s Legal Counsel Notices
Form 1 - To be completed and signed by the Agency and the Contractor
Last Revised 7/17/06
Form 2 - To be completed and signed by the Agency and its EAO
Form 3 - To be completed and signed by the Agency’s ACCO and MOCS/CCPO (if required)
CITY OF NEW YORK
Agency
Unit/Div
CONTRACT CHANGE ORDER – Form 1: Contractor Proposal
PROJECT IDENTIFICATION
Contract Title/Description:
Contract Registration No.:
FMS Project ID:
Procurement Identification Number (PIN #):
FMS Project ID Description:
Agency Contract No.:
FMS Occurrence ID:
CONTRACTOR / CONSULTANT INFORMATION
Contractor Name:
Contractor Address:
Contractor Telephone:
Goods/Services Provided by this Contract (e.g., Design, Construction,
If this is a Construction Contract,
CM, etc.):
Name of the Design Consultant:
CHANGE ORDER INFORMATION
Change Order (CO) No.:
or Over/Underrun(OR) No.:
Original Contract Award Amount:
Change Order Title:
: Describe the work to be performed in this Contract Change (use additional pages, if
Change Order Description
necessary)
Check if addtl page(s) is attached
Contract Proposal
Authorized Cost
$
-
$
-
1. Contractor shall not proceed with this work until issued a Contract Change or otherwise directed by the Commissioner. All work begun before Contract Change is
registered by the Comptroller’s Office is done at the Contractor’s own risk.
2. All work is subject to audit by the Department’s Engineering Audit Officer and to post-audit by the Comptroller’s Chief Engineer.
3. All payments for extra work must be requisitioned separately from payments for work required under the original Contract (except at Final Payments).
AUTHORIZED SIGNATURES
CONTRACTOR APPROVAL
AGENCY APPROVAL
Submitted above is my cost proposal for contract change. The
The amount of this contract is approved. Payment will be made in
Contractor certifies that the cost and pricing data submitted are
accordance with the agreement and shall not exceed the final
accurate, complete and current as of this date.
authorized cost. Payment may not be made prior to registration of this
contract change by the Comptroller’s Office.
Contractor Signature:
Authorized Signature:
Name:
Name:
Title:
Date:
Title:
Date:
Telephone No.:
Telephone No.:
Contractor Agrees with Authorized Cost
The Contractor agrees to perform the work described in this contract
change in accordance with the final authorized cost set forth above.
Basis of Payment
Time and Materials
Contractor Signature:
Lump Sum
Name:
Unit Price
Title:
Date:
Cost Plus Fixed Fee
Telephone No.:
Overrun/Underrun
Placeholder for Agency’s Legal Counsel Notices
Form 1 - To be completed and signed by the Agency and the Contractor
Last Revised 7/17/06
Form 2 - To be completed and signed by the Agency and its EAO
Form 3 - To be completed and signed by the Agency’s ACCO and MOCS/CCPO (if required)