Construction Program Management and Inspection Guide
Appendix G (continued)
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CALIFORNIA DIVISION
RECORD OF PRIOR APPROVAL FOR MAJOR CONTRACT CHANGE ORDER |
| PROJECT NO. | CCO NO. | CONTRACT NO. | DIST-CO-RTE-PM |
| REQUESTED BY: |
___ CALTRANS HQ
___ RE/DISTRICT |
DATE: |
| PROPOSED CHANGE: |
| REASON FOR CHANGE: |
| AS DISCUSSED IN FIELD (REPORT NO. __________) |
TIME EXTENSIONS
 NONE _____ DAYS DEFERRED |
ACTIVITY ON CRITICAL PATH AFFECTED BY CCO (IF TIME EXTENSION INVOLVED) |
ESTIMATE OF COST:
$_____ INCREASE DECREASE |
CCO: METHOD OF PAYMENT
CONTRACT ITEMS ADJUSTMENT OF COMPENSATION
AGREED PRICE EXTRA WORK AT FORCE ACCOUNT
|
THE WORK COVERED BY THE PROPOSED REVISION AS DESCRIBED ABOVE IS APPROVED SUBJECT TO SUBMISSION OF SUPPORTING DOCUMENTATION INCLUDING COST EVALUATION ANDJUSTIFICATION OF TIME EXTENTIONS.
OTHER CONDITIONS:
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| PRIOR APPROVAL TO PROCEED GRANTED BY: |
DATE OF AUTHORIZATION: |
Form FHWA CA-358 ©Converted to Word 1/01 (Copy to CT)
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