Reason

Code Title
Changes performed to meet or improve
21 original quality and intent of project.
Cost saving proposal from the Project
22 Manager

23 Error in Plans, Specifications, and Design

New requirements became available after

24 the contract was awarded.
Scope changes either increasing or
25 decreasing original design intent

26 Changed conditions

27 Cost reduction proposal

28 Construction Engineering error

Modifications to correct or accept
deficiencies in Contractor's workmanship
29 or materials

Added or Extra Work, shown as an

anticipated item, needed to complete the
30 project
Delays within the not
by things original
underdesign intent.
control of
Contractor other than those caused by
31 utilities.

32 Delays or conflicts associated with utilities

Work Types:

A None of the below

B Bridge
C Roadway
D Geotech
E Environmental
F Traffic
G Staging
H Drainage
I Material Sources/Disposal Sites
J Hazmat
K Mobility
Example
 ORDER FOR FORCE WORK
NOTICE: THIS FORM MUST BE TYPEWRITTEN
PROJECT NAME (SECTION) KEY NO. REGION CONTRACT NO.

WORK TO BE DONE BY: (STATE FORCE, UTILITY, RAILROAD, LOCAL GOVERNMENT, ETC. -- BY NAME) F.A. PROJECT NO.

PROJECT MANAGER AGENCY PM EXPENDITURE ACCOUNT

PM (CONSULTANT OR LOCAL AGENCY) NAME AND ADDRESS MAINTENANCE DIST. FORCE ORDER NO.

SUBJOB ACTIVITY

DESCRIPTION AND LOCATION OF WORK COVERED BY THIS ORDER --

ESTIMATE OF QUANTITIES AND COSTS

REASON WORK DESIGN PM

ITEM NO. CODE TYPE (E OR I) (E OR I) DESCRIPTION AMOUNT

RECOMMENDED BY LOCAL AGENCY DATE AGENCY PM (ODOT ONLY) RECOMMENDED APPROVED DATE
Print Print

Sign Sign

RECOMMENDED BY PM (IF EXTERNAL TO ODOT) DATE AREA MANAGER: NOTED RECOMMENDED APPROVED DATE
Print Print

Sign Sign

CONSTRUCTION SECTION: NOTED APPROVED DATE

ODOT (Internal): The Project Manager signs and submits the original through the Area Manager to Construction Section
ODOT (Outsourced): The Project Manager submits original to Agency PM (ODOT PM or Local Agency Liaison), as appropriate, who then submits through the Area Manager to Construction.
All Projects: Construction will distribute fully signed copies to the Project Manager, Agency PM, and others as appropriate.

PLEASE PROVIDE WRITTEN WORK COMPLETION NOTIFICATION

TO THE CONSTRUCTION SECTION CONTRACT ADMINISTRATION
734-1105 (1-2012)
 WORK OR CHANGE ORDER SUPPORTING DATA
PROJECT NAME (SECTION) CONTRACT NO.

0 0
HIGHWAY F.A. PROJECT NO.

0
NET EFFECT OF ORDER ON PROJECT AMOUNT CONSTRUCTION AUTH. EST. PROJECT COST W/ORDER OVERRUN %
Increas
Decrease $0.00 #DIV/0!
e
ESTIMATED STARTING DATE* OR DATE WORK WAS STARTED* WORK/CHANGE IS MAJOR? TO ACCOMPANY (ORDER TYPE & NUMBER)

Yes No FO 0
PREPARED BY DATE REVIEWED BY AREA MANAGER DATE

WORK OR CHANGE HAS BEEN DISCUSSED WITH

Name Title Name Title DATE

BY
Name Title Name Title DATE

BY
Name Title Name Title DATE

BY
Name Title Name Title DATE

BY
PRIOR APPROVAL TO PROCEED WITH THE WORK OR CHANGE HAS BEEN OBTAINED FROM*
Name Title Name Title DATE

BY
Name Title Name Title DATE

BY
Name Title Name Title DATE

BY
WORK OR CHANGE HAS BEEN DISCUSSED WITH FHWA
Name Title Name Title DATE

BY
FHWA TENTATIVE APPROVAL OBTAINED FROM
Name Title Name Title DATE

BY
FOR CONTRACT CHANGE ORDERS THAT CHANGE A CONTRACT PRICE OR DETERMINE A NEW PRICE --
PM's COST ESTIMATE IS ATTACHED: Yes No, Explain below
ADDITIONAL INFORMATION THAT IS NOT INCLUDED ON ORDER (Additional Description; Who requested; Why necessary; Why cost is not a contractor responsibility; Parties other that State or
FHWA that have agreed to share the costs; Emergency work prior to approval; Estimate effect on project time; Significant discussions; References to supporting and / or attached documents,
including estimates of costs for "Extra Work Orders" and "Force Orders"; Why contractor refuses to sign). List all previously approved overruns.

Continued on additional sheets

 Continued on additional sheets
734-1882 (1-2011) *EXCEPT IN EMERGENCY SITUATIONS, THE WORK OR CHANGE MAY NOT PROCEED WITHOUT PROPER PRIOR APPROVAL(S)
If you have any comments regarding
this form, please contact Lori Butler at
503.986.3007 or by e-mail
(lorraine.e.butler @ odot.state.or.us)

To force a line break select

Alt+Enter

The two description boxes to the left are

text boxes. You must click in the box to
use it (you cannot tab into it). This allows
the entire box to be filled with text (and
printed). Tabs can be created by using
Ctrl+Tab. Blank lines can be create by
using Ctrl+Enter.
 There are two boxes to the left that
will enable you to enter
information. Some customers could
no longer use the text box, so it
was changed to this format to
enable all customers to use the
current form. Only 1,024 characters
will print from each cell.

s
s