Public Services and Procurement Canada
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Contractor (Name and Address):
Change Order No.:
Contract No.:
Project No.:
Description and Location of Work:
Original Amount of Contract:
Approved C.O. Amount to Date:
Present C.O. Amount:
Revised Contract Amount:
Recommended:
Signature: ___________________________________________
Date (YYYY-MM-DD):
2nd Signature (if applicable): ___________________________________________
Date (YYYY-MM-DD) 2:
Approved:
Date (YYYY-MM-DD) 3:
Contractor (Name and Address) 2:
Change Order No. 2:
Contract No. 2:
Project No. 2:
Description and Location of Work 2:
Reasons for Change:
Pursuant to section 32(1) of the Financial Administration Act, funds are available.
Signature (Mandatory): ___________________________________________
Date (YYYY-MM-DD) 4:
THIS PAGE IS NOT TO BE DISTRIBUTED TO THE CONTRACTOR
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