HomeMy WebLinkAboutPublic Contract Change Order Approval Form TOWN OF SOUTHOLD
PUBLIC CONTRACT CHANGE ORDER APPROVAL FORM
This form must be completed when a Public Contract Change Order
increase is:
a} $1,000 or more
b) It is a minimum of 10% over the original contract award
FAX FORM TO TOWN ATTORNEY'S OFFICE * 631/765-6639
DEPARTMENT:
TOWN BOARD RESOL. ///DATE:
ORIGINAL CONTRACT AMOUNT:
REASON FOR INCREASE:
DEPARTMENT HEAD SIGNATURE:
DATE:
VENDOR NAME:
INCREASE AMOUNT:
Town Attorney Authorization
a Approved Date
a Denied Date
Reason for Denial
Rebid: a Yes a No
Town Attorney Authorization
Date
Comptroller Approval
Comptroller Signature
Date
Rec'd by Comptroller
Sent to Town Attorney
Rec'd Back From TA
6/2/10