Action Construction Management, Inc. t/a The Dagit Group
Purchase Order / Change Order Request Form
Name of person requesting CO:
*
Mike Troost
Mike Padin
Steve Callaghan
Steve O'Neill
Jim Baldo
Robert Plummer
Ronni Allen
Victor Taveras
Miguel Colon
Date
*
-
Month
-
Day
Year
Date
Job Name:
Job Number:
*
Vendor Name:
*
Description/ Scope:
Amount ($):
*
Cost Code:
Is this a budgeted cost code?
Yes
No
Is this a budget buster?
Yes
No
Is the PO scope billable as an Owner Change Order?
Yes
No
If billable, amount Quoted to Customer/Owner/Owner Rep?
If billable, name of Owner/Owner Rep. approving?
Billable to whom:
Company (i.e.: McD's, Wendy's, Wawa, etc.) (If McD's - is this a shared cost)
Owner Direct
If a Change Order, what is the reason for the Change Order Request?
Design Modification
Change in Plans/Drawings
Jurisdictional Requirement
Franchisee Request
Owner Request
Hidden Conditions
Other
Days, if any, added to the schedule due to this Change Order?
Upload Vendor's Estimate and/or Owner Approval Documentation:
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