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reference is to be made to the original Contract Documents.
Detailed Labor and Material: Required_______________ Not Required___________________
Attachments: (Specify) _________________________________________________ Description of Proposed Changes:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
This is not an order to proceed with work unless signed below.
The undersigned hereby acknowledges that Subcontractor is authorized to perform the work and provide the material described above as an extra to the Contract. Adjustments to the contract price caused by this extra work and material shall be computed and paid for at the fair and reasonable value of the work and material.
Authorized Signature: _________________________ Date: ____________________________
Position:____________________________________
Company Name: _____________________________ (Continued)

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