Form 104 "Contract Change Order" - Montana

This version of the form is not currently in use and is provided for reference only.
Download this version of Form 104 for the current year.

What Is Form 104?

This is a legal form that was released by the Montana Department of Administration - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Montana Department of Administration;
  • 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 fillable version of Form 104 by clicking the link below or browse more documents and templates provided by the Montana Department of Administration.

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Download Form 104 "Contract Change Order" - Montana

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Clear Form
STATE OF MONTANA
DEPARTMENT OF AD MI NISTRAT ION
ARCHITECTURE AND ENGINEERING DIVISION
1520 East Sixth Avenue • P.O. Box 200103 • Helena MT
59620-0103 Phone: 406 444-3104 • Fax: 406 444-3399
CONTRACT CHANGE ORDER
Project Name:
A/E #:
Location:
Chg. Order #:
Contractor:
Date:
Address:
Phone:
The Contractor is hereby directed to make the following changes in the Contract:
COST
ITEM
DESCRIPTION/UNIT BREAKDOWN/UNIT COSTS
(Indicate + or -)
NO
(Indicate Critical Path Schedule impact for each Item)
.
TOTAL FROM PAGE 2
$ 0.00
$ 0.00
SUBTOTAL (Labor & Materials) =
O&P Included above:
Calculate O&P
Overhead & Profit @ ___% =
$ 0.00
15
TOTAL COST (This Change Order Only) =
$ 0.00
Change In Contract Duration/Time By This Change Order:
No Change
Increase
Decrease
BY
CALENDAR DAYS.
NEW CONTRACT COMPLETION DATE:
CONTRACT STATUS
1. Original Contract Amount
2. Net Change by Previous Change Order(s)
3. Current Contract Amount (1+2)
$ 0.00
4. This Change Order Total Amount
$ 0.00
$ 0.00
5. New Contract Amount (3+4)
6. Total Cost of All Change Orders to Date (2+4)
$ 0.00
Contract Change Order (Rev 3/19)
Form 104
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Clear Form
STATE OF MONTANA
DEPARTMENT OF AD MI NISTRAT ION
ARCHITECTURE AND ENGINEERING DIVISION
1520 East Sixth Avenue • P.O. Box 200103 • Helena MT
59620-0103 Phone: 406 444-3104 • Fax: 406 444-3399
CONTRACT CHANGE ORDER
Project Name:
A/E #:
Location:
Chg. Order #:
Contractor:
Date:
Address:
Phone:
The Contractor is hereby directed to make the following changes in the Contract:
COST
ITEM
DESCRIPTION/UNIT BREAKDOWN/UNIT COSTS
(Indicate + or -)
NO
(Indicate Critical Path Schedule impact for each Item)
.
TOTAL FROM PAGE 2
$ 0.00
$ 0.00
SUBTOTAL (Labor & Materials) =
O&P Included above:
Calculate O&P
Overhead & Profit @ ___% =
$ 0.00
15
TOTAL COST (This Change Order Only) =
$ 0.00
Change In Contract Duration/Time By This Change Order:
No Change
Increase
Decrease
BY
CALENDAR DAYS.
NEW CONTRACT COMPLETION DATE:
CONTRACT STATUS
1. Original Contract Amount
2. Net Change by Previous Change Order(s)
3. Current Contract Amount (1+2)
$ 0.00
4. This Change Order Total Amount
$ 0.00
$ 0.00
5. New Contract Amount (3+4)
6. Total Cost of All Change Orders to Date (2+4)
$ 0.00
Contract Change Order (Rev 3/19)
Form 104
1 of 3
A/E #:
Change Order #:
ITEM
DESCRIPTION/UNIT BREAKDOWN/UNIT COSTS
COST
(Indicate Critical Path Schedule impact for each Item)
NO
(Indicate + or -)
.
$ 0.00
SUBTOTAL (Labor & Materials) this page only. Carry forward to first page. =
Contract Change Order (Rev 3/19)
Form 104
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A/E #:
Change Order #:
JUSTIFICATION FOR CHANGE(S) (To be completed by Architect/Engineer):
Describe the details which mandate the change(s).
JUSTIFICATION FOR COST ADJUSTMENT (To be completed by Architect/Engineer):
Describe the basis used to calculate the cost adjustment.
JUSTIFICATION FOR SCHEDULE ADJUSTMENT (To be completed by Architect/Engineer):
Describe the impact of adjustment(s) to the critical path.
APPROVALS
By signature on this change order, the Contractor certifies that this change order is complete and includes all direct costs, indirect costs and
consequential items (including additional time, if any) and is free and clear of any and all claims or disputes (including, but not limited to, additional costs,
additional time, disruptions, and impacts) in favor of the Contractor, subcontractors, material suppliers, or other persons or entities concerning this
change order and on all previously contracted Work and does hereby release the Owner from such.
Approved by Contractor:
By:
Date:
Recommended by
By:
Date:
Architect/Engineer:
Reviewed by Agency:
By:
Date:
Surety Consent:
SURETY CONSENT IS REQUIRED IF THE TOTAL AMOUNT OF ALL CHANGE ORDERS (LINE 6) EXCEEDS
10% OF THE ORIGINAL CONTRACT AMOUNT.
The Surety consents to this Contract Change Order and agrees that its bond or bonds shall apply and extend to the Contract as
modified or amended per this Change Order. The principal and the Surety further agree that on or after execution of this consent,
the penalty of the applicable Performance Bond and Labor & Material Bond is increased by:
(
)
By One Hundred Percent (100%) of ALL Change Orders
Countersigned by Resident Agent:
Date:
Surety:
Recommended by: A&E Project Manager:
Date:
Accepted by: Montana Dept. of Administration:
Date:
Architecture & Engineering Division
Contract Change Order (Rev 3/19)
Form 104
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