Amendment/Change Order/Renewal Request

Amendment/Change Order/Renewal Request

Contract Number*

What is the contract number that you would like to amend or renew?

Amendment/Change Order/Renewal Number*

Example: Amendment #1/#2, Change Order #1/#2, Renewal Year 1/Year 2 etc.

Vendor*

Who is the current vendor?

Project Description*

What is the name of the current contract project?

City Dept.*

What department are you from?

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Project Manager*

Who is the project manager?

Requester*

Who is entering this amendment/change order/renewal request?

Summary of Change Order/Amndt/Renewal*

Please provide a brief (1-2 sentence) description if this is for a change order/amdnt

Change Order/Amndt Type*

Please select a change order/amdnt type.

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New Expiration Date

If this change order/amdnt will extend the contract, what is the new expiration date?

If this change order/amdnt will extend the contract, will it extend the contract over 3 years?

Contract Value

If this change order/amdnt increases the contract value, what is the revised contract value?

Budget

If the change order/amdnt increases the contract value, do you have sufficient budget to cover the increase?

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Upload Any Applicable Files

Please attach any applicable documents (revised scope; additional price detail; etc..)

Drag and drop files here or

Send me a copy of my responses