DCM Form C-12 "Contract Change Order - Fully Locally-Funded State Agency Project" - Alabama

What Is DCM Form C-12?

This is a legal form that was released by the Alabama Department of Finance, Real Property Management - Division of Construction Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2021;
  • The latest edition provided by the Alabama Department of Finance, Real Property Management - Division of Construction Management;
  • 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 DCM Form C-12 by clicking the link below or browse more documents and templates provided by the Alabama Department of Finance, Real Property Management - Division of Construction Management.

ADVERTISEMENT
ADVERTISEMENT

Download DCM Form C-12 "Contract Change Order - Fully Locally-Funded State Agency Project" - Alabama

Download PDF

Fill PDF online

Rate (4.4 / 5) 19 votes
DCM Form C-12 (fully locally-funded State Agency project)
Do not staple forms and/or attachments; use clips. Print
August 2021
single-sided; do not submit double-side printed documents.
A Change Order is not valid without an accompanying
completed Change Order Justification (DCM Form B-11).
CONTRACT CHANGE ORDER
DCM (BC) No. ________________
Change Order No. __________
Date ___________________
PROJECT:
TO (Contractor):
Co. Name:
Address:
TERMS: You are hereby authorized, subject to the provisions of your Contract for this project, to make the
following changes thereto in accordance with your proposal(s) dated _________________________________________
________________________________________________________________________________________________.
FURNISH the necessary labor, materials, and equipment to (Description of work to be done or changes to be made. If
the description is continued in an attachment, identify the attachment below.):
Page 1 of 2
DCM Form C-12 (fully locally-funded State Agency project)
Do not staple forms and/or attachments; use clips. Print
August 2021
single-sided; do not submit double-side printed documents.
A Change Order is not valid without an accompanying
completed Change Order Justification (DCM Form B-11).
CONTRACT CHANGE ORDER
DCM (BC) No. ________________
Change Order No. __________
Date ___________________
PROJECT:
TO (Contractor):
Co. Name:
Address:
TERMS: You are hereby authorized, subject to the provisions of your Contract for this project, to make the
following changes thereto in accordance with your proposal(s) dated _________________________________________
________________________________________________________________________________________________.
FURNISH the necessary labor, materials, and equipment to (Description of work to be done or changes to be made. If
the description is continued in an attachment, identify the attachment below.):
Page 1 of 2
DCM Form C-12 (fully locally-funded State Agency project)
August 2021
Description continued from Page 1:
_________________________________________________________________________________
ORIGINAL CONTRACT SUM
$ _______________________
NET TOTAL OF PREVIOUS CHANGE ORDERS
$ _______________________
PREVIOUS REVISED CONTRACT SUM
$ _______________________
This change order will
increase
decrease the contract sum by
$ _______________________
REVISED CONTRACT SUM, INCLUDING THIS CHANGE ORDER
$ _______________________
EXTENSION OF TIME resulting from this Change Order
None
or
______ Calendar days.
The Owner certifies this Change Order was executed in accordance with the provisions of Title 39, Code of Alabama, 1975, as amended.
APPROVALS
CONTRACTING PARTIES
________________________________________________
Contractor Company
By ____________________________
______________
Date:
Governor (all State Agency projects except ABRFA)
By _____________________________________________
Signature
By
______________________________________
__________________________________________________________
Name & Title
Secretary of State (Conservation projects only)
________________________________________________
By
__________________________________________________________
Owner Entity
Add'l Agency, Title:
By _____________________________________________
Signature
______________________________________
Name & Title
_________________________________________________
Architectural/Engineering Firm
Additional Owner Entity signature space if needed:
Recommended By _________________________________
________________________________________________
Signature
Owner Entity
______________________________________
Name & Title
By _____________________________________________
Signature
ALABAMA DEPARTMENT OF FINANCE,
REAL PROPERTY MANAGEMENT (RPM),
______________________________________
Name & Title
DIVISION OF CONSTRUCTION MANAGEMENT (DCM)
The Awarding Authority/Owner certifies that funds are
available in the amount required for this Change Order.
By _____________________________________________
CONSENT OF SURETY
(for additive $ change orders only)
Finance Director (Finance, sub-Finance & ABRFA projects only)
________________________________________________
Surety Company
By _____________________________________________
RPM Director (Finance, sub-Finance & ABRFA projects only)
By _____________________________________________
Signature (Attach current Power of Attorney)
By
________________________________________________________
Name & Title _______________________________________________
DCM Director (all State Agency projects)
Reviewed By _____________________________________
DCM Contract Administrator (all State Agency projects)
Review/Signature flow: Architect/Engineer (prepare documents) > Contractor (review and sign) (> Surety for additive $ changes
only [sign]) > Architect/Engineer (review and sign) > Owner (review and sign) > RPM/DCM (review and sign) > Finance-Legal
(> Finance, Finance sub-Agencies & Alabama Building Renovation Finance Authority [ABRFA] projects then go to Finance
Director [review and sign]) > Governor (review and sign) (> Conservation projects then go to Secretary of State [review and
sign]) > DCM (distribute fully executed Change Order to all parties). Note: Transportation inserts an additional signature sheet.
Page 2 of 2
Page of 2