Customer:City of Arlington – Public Works & IT Departments
Requested By:Precision Networks
Location:Matlock Rd corridor south of Green Oaks Blvd
Prepared By:Name / Title
Reason for Change
Description of Change in Scope
Schedule Impact
Added Working Days
0
Revised Completion
MM/DD/YYYY
Schedule Notes
No impact to critical path / awaiting City approval to proceed
Cost Impact — Labor & Materials
Use negative quantities for credit/deduct line items. Totals update automatically.
Labor
Description
Qty
Unit Price
Amount
Labor Subtotal:$0.00
Materials
Description
Qty
Unit Price
Amount
Materials Subtotal:$0.00
Original Work Order Amount$16,088.75
Previously Approved Change Orders$0.00
This Change Order$0.00
Revised Work Order Total$0.00
Change Order Notes
• This change order is valid for 30 days from the date above.
• Work will be billed on a time & materials basis; actual quantities may vary based on field conditions.
• No changed work shall proceed without written approval of this change order.
• All work performed in accordance with City of Arlington standards and applicable codes.
Authorization
Requested By (Contractor) — Signature / Date
Approved By (Customer) — Signature / Date
Approval of this change order authorizes the contractor to proceed with the changed work and amends the original work order amount accordingly.