HTML Preview Scope of Work Change Order Form page number 1.
Minnesota Weatherization Assistance Program Revised July 2015
SCOPE OF WORK CHANGE ORDER FORM
Client name: ____________________ Contractor :_____________________ Client ID#_____________________
Work Order Name
Meas. #
Measure Type
Type of Change
Orig.
Cost
Final
Cost
Orig.
SIR
Final
SIR
1
ECM/IRM/HSM Add/Delete/ChangeInCost
Reason:
2
ECM/IRM/HSM Add/Delete/ChangeInCost
Reason:
3
ECM/IRM/HSM Add/Delete/ChangeInCost
Reason:
4
ECM/IRM/HSM Add/Delete/ChangeInCost
Reason:
5
ECM/IRM/HSM Add/Delete/ChangeInCost
Reason:
6
ECM/IRM/HSM Add/Delete/ChangeInCost
Reason:
Sent on:
Complete by:
Original Job SIR
Final Job SIR
Client Signature (required only when measures are added or deleted) Date
Contractor Signature (required): Date
Service Provider Representative Signature (required) Date