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Contract Change Clause
The Change Order Process

Annual Program of the

Claims Avoidance and Resolution Committee

of the Construction Institute

March 11, 2010 – Los Angeles

Prepared by Changes Clause Subcommittee

Dan Becker – Chair
Michael Radbill
Hal McKittrick
Joe Ramaglia

Changes are a Natural Part
of Construction

Changes may have both cost and schedule impacts.

Dealing with changes promptly will have the least amount of impact on the budget and schedule.

Delaying resolution can increase costs, jobsite friction, delay the completion of the project and result in a dispute.

Reasons for Changes

Differing site conditions.
Regulatory changes.
Owner changes.
Scope added/deleted during construction – field changes.
Late design changes.
Changes in Owner-provide equipment.
Start-up changes
Information missing from the CD’s; errors and omissions
Schedule delays and revisions.
Adverse weather and other force majeure events.

Owner’s Perceptions of Change Orders

Original Contract

Contract Changes Presentation Goals

Define a change order process

Provide recommended provisions to include in your contracts

Contract Changes Presentation

Process Elements
Notifications
Preparing Change Proposals
Overhead Costs
Change Management Process/System

Construction Institute

Claims Avoidance and Resolution Committee

Construction Institute Claims Avoidance and Resolution Committee

Change Process Elements

Define the Process
Change Proposal Submittal
Scope
Timing
Pricing the Change Order Request
Time and Materials Work
Schedule Impacts

EJCDC

Many of the terms and processes included in this presentation are based on the Engineers Joint Contract Documents Committee Standard (EJCDC) General Conditions.

Issued and Published by:
American Society of Civil Engineers
American Council of Engineering Companies
National Society of Professional Engineers

Disclaimer: Terms used here may vary depending on the Owner,

process, and/or contract used.

Change Order Clauses

Most construction contracts state “… the Owner has the right to issue changes without invalidating the Contract.”
EJCDC – Article 10.01 (Work Change Directive or Change Order)
AIA A201 – Section 7.3.1 (Construction Change Directive)
FAR Contracts – Section 52.243

Defining the Elements

Work Change Directive (WCD) – A statement to the Contractor from the Owner (design team, Owner’s Rep, CM, etc.) requesting an addition, deletion, or change to the work.
Field Directive (FD) – Written directive from the Owner directing a minor change to the work that will not impact the contract price or time.
If the Contractor feels the WCD or FD impacts the budget or schedule, it is required to notify the Owner.
Change Request (CR) – Notification from the Contractor to the Owner of a change to the Contract time and/or schedule

Defining the Elements

Change Order (CO) – Document that incorporates changes to the scope, price and/or time into the Agreement/Contract.
Bilateral Change Order – Change Order whereby both the Owner and Contractor agree to adjustment to the price and time.
Unilateral Change Order – Change Order issued by the Owner when the Owner and Contractor cannot come to an agreement on the price and time.
Claims – A demand or assertion by the Contractor (or Owner) for an adjustment to the contract time or price.

Owner Directed
Change Process

The General Conditions of the Contract define the process to follow.

Yes

Send WCD/FD to Contractor

Reach Agreement

Yes

Contractor Determine if cost/schedule impact

Contractor Notify the Owner that cost or schedule will be impacted

Contractor perform the work

Issue Unilateral Change

Owner Review Contractor's Submittal

Yes

Execute Change Order

Contractor Prepares Cost & Time Estimate

Negotiate cost and schedule Impacts with Contractor

Withdraw WCD / FD

Prepare Engineer’s Estimate of Time and Cost Impact

Prepare WCD or FD

Contractor Change Request Process

Most Contracts do not spell out a “Contractor Change Request” process.

If the Contractor wants to submit a change request it needs to follow the “claims” process defined in the contract to request a change.

Yes

CR Accepted

Contractor Notifies the Owner with Change Request

Reach Agreement

Contractor Identifies a Change

Prepare Engineer’s Estimate of Time and Cost Impact

Withdraw WCD / FD

Contractor Prepares Cost & Time Estimate

Negotiate Cost and ScheduleImpacts with Contractor

Owner Review Contractor's Submittal

Owner’s Review

Contractor Prepares Claim

Contractor Withdraws Request

CR Rejected Options

Execute Change Order

Issue Unilateral Change

Notification Requirements

EJCDC Contract states that the Contractor must notify the Owner within 30 days of notification of the change by way of the Claims clause. (Section 10)
The AIA document has no requirement for submittal of Change Proposal.
FAR General Conditions state that the contractor must assert its rights for added costs and/or time within 30 days of notice of change. (Section 53-243-4)

Include a requirement in the Contract’s General or Special Conditions or Division 1 such as:

“The Contractor has 10 days to provide the Owner with their cost and schedule impacts resulting from this Work Change Directive.”

If the Contractor is “allowed” to extend the submittal date, don’t let the proposal submittal extend indefinitely.
Benefits:
Receive the information early enough to make a decision on whether to move forward with this change or an alternative.
Resolve issue while fresh in everyone’s mind.
Reduces ability to claim at the end of construction.

Recommended Practice

Notification Requirements

Sample Change Form

Include a proposal return date

Change Request

Title:

No.:

Request Date:
Project:
Contractor:
Contract No.:		WO Contract No.:

Initiated by:

Owner

Engineer

Contractor

Other:

Change Request

The following change is proposed for the project. Please provide us with your proposed cost and schedule changes for this request as described below (use additional pages if necessary):

This work shall be constructed in accordance with the terms and conditions of the Contract Documents.

The Contractor shall provide it’s proposal for this work by _____________________________.

Contractors Proposal:

Increase

Decrease $

Increase

Decrease

Days

Recommendation:

Amount $

Comments


	Accept	Reject		Accept	Reject

HDR Engineering, Inc.	Date	Otak	Date

Local Programs:

	Accepted	Rejected	By:	Date:
*Utility Provider:* (if required)
	Accepted	Rejected	By:	Date:

City:

Accepted

Rejected

By:

Date:

Work Change Directive
Proposal Submittal Requirements

Pricing Changes
Forward pricing changes (direct and indirect costs)
Time and Material pricing
Define the basis for costs
Labor rates
Equipment
Materials
Define mark-ups
Define mark-up distribution

Forward Pricing Changes

Agree on the change order price before the Contractor begins the added work

Risk shifts from Owner to Contractor

Need to address how to price or agree to the price for “potential” inefficiencies in forward pricing

Advantages of Forward Pricing Changes

Owner – Certainty of the cost and schedule impacts before changed work starts

Contractor – Payment for the changed work when changed work is performed

Owner – They may feel they are paying more than the change is worth.

Contractor – Changed work may cost more and/or take longer to complete than the agreed amount.

Risks of Forward Pricing Changes

Final Thoughts on Forward Pricing Changes

Lump Sum Proposal supported with cost breakdown.
Some contracts define how changes should be priced in the changes clause. (AIA Section 7.3.6, NYC Contract Article 26)
Others default to other clauses such as force account or accounting clauses. (EJCDC directs to Section 11.01, Section 15.4 of the FAR)

Define how the Contractor should price labor, materials, equipment, construction equipment and tools in the Contract.

If you cannot include this in the contract, then…

Agree on how you plan to price labor, materials and equipment at the start of the project, before the first change is issued.

Recommended Practice

Forward Pricing Changes

Defining Basis for Costs

Determine how labor productivity will be defined: actual, projected, or industry defined production rates.
Labor wage rates
Davis Bacon
Prevailing Wage Rates
Contractor’s actual payroll

Actual labor costs or blended rates.

Forward Pricing Changes

Material prices based on:
Invoices
Quotes
Audited costs

Construction Equipment prices based on:
Invoices
Quotes
Contractor’s accounting records
AGC/Blue Book/Green Book

Change Order Mark-ups

Some contracts define mark-ups.

Typical mark-ups:
Labor 10% to 30%
Materials 10% to 20%
Equipment 10% to 20%
Subcontractor work 5% to 20%

EJCDC Mark-ups

EJCDC Contract Mark-ups.
Labor 15%
Materials & Equipment 15%
Construction Equipment 15%
Subcontractor work 5%

AIA Document Addresses Mark-ups

“…cost plus a reasonable sum for Overhead and Profit.”

NYC Contract Mark-ups

NYC Contract Mark-ups.
Overhead
Labor 8% to 10%
Materials & Equipment 8% to 10%
Construction Equipment 8% to 10%

Profit 10%

Florida DOT

Labor 17.5%
Materials & Equipment 17.5%
Construction Equipment 17.5%
Subcontractor work 10% for first $50,000,

5% for amounts > $50k

+ Bond Costs

Caltrans

Labor 33%
Materials 15%
Equipment 15%
Subcontractor work 5%

State of California
Depart of General Services

Allowable Contractor Mark-ups
Labor 21 %
Materials and Equipment 16 %
Subcontract Work 6 %
These costs include bond costs

Allowable Subcontractor Mark-ups
Labor 20 %
Materials and Equipment 15 %
All Subcontract tiers shall not exceed 20 % for labor and 15 % for materials and equipment

ConsensusDOCS

“…costs calculated on a basis agreed upon by the Owner and Contractor plus ___% Overhead and ___% profit; or

…

“…if there is a net increase in the Contract Price, the Contractor’s Overhead and profit shall be adjusted accordingly.”

In case of a net decrease in the Contract Price, the Contractor’s Overhead and profit shall not be adjusted unless ten percent (10%) or more of the Project is deleted.

Time & Materials/
Force Account

When Owner and Contractor cannot agree on the costs, Owner issues the change directive to be performed on a time and materials basis.
Risk is on Owner vs Contractor
Payment based on actual costs plus agreed on mark-ups.
Daily T&M sheets are completed and signed by the Contractor and Owner.
Payment is made after incorporated into the Contract by Change Order.
The contract should state what support activities and costs will be included in a time and materials change.

Advantages/Disadvantages
to T&M

Advantages
Owner – Work starts on change when directed; reduces potential for schedule impacts
Contractor – Certainty of costs after the work is completed
Disadvantages
Owner – Uncertainty of costs when the change work begins
Contractor – Loses ability to make more money on efficiencies

Change Order Mark-ups

Define mark-ups in the Contract.

Mark-ups should be reasonable and consistent with area practices.

If you can’t put them in the Contract, then negotiate the rates at the start of the project as a first order of business.

Recommended Practice

Time & Materials Work

Issue a Not-to-Exceed amount for the changed work.

Mark-ups (profit) for Time & Materials should be reduced due to reduced risk.

If you can’t put them in the Contract, then negotiate the rates at the start of the project.

Recommended Practice

Field office – Identify facilities, office equipment, etc.
Field staff – Project Manager, Superintendent, Field Engineers, administrative support, etc.
Home office – Office expenses, officers, legal, accounting, etc.
Insurance
Bonds
Profit/Fee
State whether OH included in the mark-ups is applied to any contract time extensions

Identify what the mark-ups cover

Recommended Practice

Proposal Submittal Requirements

Schedule Impacts
Include schedule impacts in all changes to avoid schedule impact claims at the end of the project.
Require a preliminary Time Impact Analysis (TIA) with any schedule extension request and a TIA 30 days after the event is complete.
Negotiate extended overhead and/or acceleration issue NOW – otherwise constructive acceleration.
Agree on new project end date.

Recommended Practice

Cost of Extended Overhead

Agree to extended overhead amount when you agree to the new contract completion date.

Costs for extended overhead based on:
“Modified” Eichleay
Negotiated Amount/Rate
Time related overhead

NOTE: Some States have regulations prohibiting “No damages for delay clauses.”

Time Related Overhead (TRO)

California Department of Transportation (Caltrans) uses TRO on some Unit Price contracts
Bid Item either:
Lump sum (divided by the number of contract days)
Daily Rate

Contract states that the rate will be used for any schedule extension up to 180 days beyond original contract completion date.

Calculating Time-Related-Overhead

Lump Sum Overhead Amount	$1,534,500.00
Contract Days (working days)	620
Daily Rate	$ 2,475.00/day
Days Added by Change Order	12 days
Extended Overhead Amount to be included in Change Order	$ 29,700.00

Define what is included in the extended overhead:
Construction support equipment (cranes, forklifts, etc.)
Field office – Identify facilities, office equipment, etc.
Field staff - Project Manager, Superintendent, Field Engineers, administrative support, etc.
Home office – Office expenses, officers, legal, accounting, etc.

Recommended Practice

Identify How to Calculate Extended OH

Managing the CO Process

Develop a system for tracking changes
Track status/disposition of the change
Meeting regularly with the Contractor to resolve changes
Meeting regularly with the Owner to resolve changes

Sample Two Step Process

Step 1: Work Change Directives
Initiates the process
Resolves distinct issues

Step 2: Change Orders
Needed to incorporate changes into contract
Accumulates Change Requests into single CO; thereby reducing the approvals by the client’s board

Construction Institute

Claims Avoidance and Resolution Committee

Construction Institute Claims Avoidance and Resolution Committee

104.pdf

No. Date

Initiated Description Status

Change

Type (FA,

UP, LS)

Initiated

Engineer's

Estimate

Date C.R.

Form sent

Contractor

Kenmore WSDOT Utility (if

applicable)

Date

Rec'd

Amount

Prpsd City WSDOT Design

Utility (if

applicable)

C.O.

& Pay

Est.

No.

Payment Bid

Item

Number(s)

Change

Request

Cost

Comments

1 8/30/07 Additional 150 linear feet of cement concrete barrier at

STA. 9+00 to 10+50 right. C UP HDR 3,300$ 09/04/07 n/a 8/31/07 8/31/07 8/30/07 2 176 3,300$ Change Order issued on 11/12/07.

2 8/30/07 Relocation of the existing 12” water line located in the

Bioswale No. A. C UP COK 42,000$ 09/04/07 8/31/07 8/31/07 8/30/07

Pay est

5 237, 244 39,335$

MMCI paid for pipe installed under unit rates. W aiting on MMCI to provide added

costs in addition to the unit rates. Per Serial Letter No. 9 Rev 1, MMCI agrees to

perform the work per existing contract bid items, but a portion of the work is not

covered, which amounts to $8,902.

3 8/30/07

Block-out in W all No. 1 to provide passage of a

drainage pipe through the wall as shown on the

attached drawings. C FA COK 2,500$ 12/20/07 n/a 01/04/08 6,053$ PE 10 2,614$

W aiting on MMCI for cost proposal / tracked on Force Account as back-up; labor

included on force account sheets. W e need material costs and a proposal from

MMCI. 12/20 FA sheets received & being reviewed. AF sheet incomplete as of

1/21/08. HDR to take values from certified payroll for MMCI to check

4 8/30/07 Signage for Burke-Gilman Trail detour. C FA/UP COK 40,000$ (construction

meeting notes) 08/30/07 n/a 07/20/08 98,000$ 11/14/07 11/13/07 - - 4 237 $23,253.55

W aiting on MMCI for cost proposal / tracked on Force Account as back-up; labor

included on force account sheets. W e need material costs and a proposal from

MMCI. FA received, W aiting on # of signs from MMCI

5 9/5/07 W SDOT temporary controller at 83rd. C none MMCI -$ 09/11/07 n/a 09/20/07 10,500$ PE 10 -$ 6/16/08: Labor costs still pending

6 9/5/07

Electrical subcontractor cost impacts associated with

the installation of the signal at 80th and delay in the

relocation of the overhead power lines. C FA MMCI 8,105$ 09/05/07 09/11/07 n/a 8,200$ PE 10 - -

Change Request Rejected by HDR - Serial letter No. 10 sent to MMCI. MMCI

provided agreement. HDR to review and schedule meeting with MMCI and their sub.

Amount proposed is original amount. Upon further acceptance of the issue and

then review of the numbers, none of the hourly rates matched. HDR is proceeding

with the certified payroll numbers as of 1/21/08

7 9/6/07 Request to prepare a cost proposal for the installation

of Raised Pavement Markers. C new BI HDR n/a 09/11/07 n/a 10/19/07 see note 11/14/07 11/13/07 - - 2 4,500$

Did not appear in bid item list but was required. HDR requested unit pricing from

MMCI. Change Order issued on 11/12/07. Agreed upon price was Type 1: $300

per 100; Type 2, $700 per 100. No signed CR, signed in CO

8 9/7/07 Asteria Sign Lighting C LS MMCI 2,000$ 09/07/07 n/a 09/20/07 5,290$ 11/14/07 11/13/07 - - 2 5,290$ Change Order issued on 11/12/07. No signed CR, signed in CO

9 10/10/07 Added 18" Ductile Iron Pipe for Bioswale A. C new BI HDR 6,300$ 11/20/07 10/11/07 n/a 5 new 6,935$ Cost Proposal received and accepted. 6/16/08 Change order pending; item

negotiated for $95 LF

10 11/8/07 The backfill behind W all #1 required filling to a point 3

feet above the top row of tie-back strands C LS MMCI 24,000$ 11/20/07 11/08/07 n/a

letter/minu

tes of

meeting

PE6,7 82 $40,000

GeoEngineers have requested that the wall be completely backfilled prior to the

testing. The material is not available that is to be used in this maneuver, and

additional Gravel Backfill for Drains is required. This totals to be @600 C.Yds. at

$40.00/yard or $24,000.00. Paid per bid item

City of Kenmore

SR 522 HOV Enhancement: Phase 2

Change Request & Issue Log

Change Documentation Approvals Rec'd Change Acknowledged Date Payment Method

Contractor's

Proposal or F/A

information

11 9/4/07 SR 522/ 77th Ct Access Road (Bowling

Alley/Starbucks) HDR FA COK 20,000$ 11/08/07 11/20/07 11/09/07 n/a

Received construction permit for the construction of the access road from OTAK on

11/06/07. Verbal approved on 11/09/07. W aiting for cost proposal from MMCI.

Items to be tracked as FA. 4/15/08: MMCI Notes added time may be needed.

5/23/08 received proposal from MMCI. Negotiated price of $32,000 and 4 working

days. Tracked on Force Account. (?)

12 9/26/07 Trailer Relocation C LS COK 17,000$ 09/26/07 11/20/07 10/29/07 n/a 21,000$ 11/14/07 11/13/07 - - 2 256 19,500$ Change Order issued on 11/12/07.

13 9/4/07

Differing site conditions encountered during drilling

operations of Shaft #13 at Pier #2 on 8/27/07 (MMCI

Serial Letter 10). C bi MMCI 10,900$ 11/20/07 11/15/07 n/a PE 5 81 9,558$ Cost proposal received on 10/19/07 as a Force Account. Paid per bid items.

14 11/14/07 Vault obstruction on the excavation of the joint utility

trench at the NE corner of SR522 and 73rd. C FA MMCI 5,000$ 11/20/07 11/15/07 n/a 17,995$ PE 5,10 15,615$

HDR gave direction to MMCI to proceed with removing this obstruction on 11/14/07.

Measurement and payment tracked via F/A methods. W aiting for cost proposal from

MMCI.

15 7/23/07 Verizon Conduits Prohibiting Stage 1 Bridge Demo

(MMCI Serial Letter 4) closed LS MMCI -$ n/a

7/7/08: need time impact delay - issues considered complete due to lack of

evidence for specification justification

16 10/3/07 W orking Hours and Lane Closure Restrictions (Serial

Letter 13). closed n/a MMCI -$ n/a

Regarding Serial Letter #13: put on notice for potential claim dated 10/3/07 in

amount of $88,800. 7/7/08: need time impact delay; issues considered complete

due to lack of evidence for specification justification

17 10/22/07 Support of Stage 1 Construction Approach Slabs

(Serial Letter 18 and 19). C LS MMCI -$ 01/20/07 11/20/07 n/a 24,000$ 4 new 10,000$

Serial Letters and emails exchanged. Amount negotiated. Change Order

processing.

18 11/15/07 Traffic Control and Business access Plan C LS COK 18,000$ 11/20/07 11/15/07 n/a (constr

mtg notes) 18,000$ 4 new

MMCI has been directed to provide an improved traffic control and business access

plan for the SR522 Corridor. There will be material and labor costs involved with this

CR. 6/16/08: agreed on price

19 10/9/07 Block-out on SE wingwall Pier 2 C FA MMCI 2,000$ 11/20/07 11/16/07 n/a 01/11/07 2,735$ PE 10 59 2,614$ Sheet D06 of the contract plans shows an 18-inch storm drain pipe coming off

catch basin 98 and intersecting through the SE wingwall. However, the SE wingwall

at pier 2 on sheet B07 doesn't show the 18" storm drain intersecting.

20 11/20/07 Power service SE of SR 522 and 73rd FA FA COK 5,000$ 11/20/07 11/21/07 n/a

There are properties located south of SR 522 and east of NE 73rd Street that

currently have their power and possibly other aerial utilities; serving them from the

north side of SR 522. W hen Phase 2 is undergrounded they will lose service. This

issue was not dealt with during design. 5/12/08: MMCI to send estimate; 9/9/09 -

tracked on Force Account

22 9/4/07 Ecology Blocks Supporting Embankment on the BGT

near 83rd. C FA MMCI n/a 01/11/08 14,672$

Contractor requests funds for this work. HDR states this is a means and methods

issue.; 9/1/09 no additional information was given and issue was resolved in the

negotiation for the trail detour payment. No agreement to pay is present

23 11/30/07 NUD W ater Line across 73rd FA UP/LS NUD 20,000$ 11/30/07 11/30/07 02/25/08 123,622$

Contractor estimate does not include traffic control and officers and includes hand

placed asphalt issue. Stalled due to hand placed asphalt issue. 5/12/08: parse out

items that have already been agreed to for payment; 8/31/09 items tracked and

paid on bid items and force account (?)

26 12/27/07 12/3/07 storm damage & damage control C FA MMCI 5,000$ 12/27/07 n/a 01/11/08 6,425$ PE 10 59 273 6,417$ flooding at private home. 12/2/09 Force Account Conversion. 0 days associated.

New Bid item 273.

27 12/27/07 Joint Utility Trench - PSE added conduit MMCI FA PSE -$ 1/1/6/08 12/27/07 pending n/a FA Project Plans do not show an additional line of conduit that PSE requires; no unit

prices are available as the original conduit was part of a lump sum item

28 1/21/08 Buried wire under Bioswale B C FA MMCI 3,400$ n/a PE 10 59 2,370$

HDR Confidential 2/16/2010 Page 1HDR Confidential 2/16/2010 Page 1

Column Headings

Initiating Information
Number
Date Initiated
Description (Brief)
Status
Change Type (FA, UP or LS)
Initiated by
Engineer’s Estimate
Date Sent to Contractor

Funding Entities Informed
Client
WSDOT (State DOT)
Utilities

Contractor’s Proposal
Date Received
Amount Proposed

Construction Institute

Claims Avoidance and Resolution Committee

Construction Institute Claims Avoidance and Resolution Committee

Column Headings

Resolution Approvals
Client (City)
WSDOT
Utilities
Additional Funding Partners

Payment Method
Change Order #
Payment Item (if applicable)
Change Order Amount

Comments – Why, why not, what else

Managing the CO Process

Dealing with changes promptly will have the least amount of impact on the budget and schedule.

Failing to resolve changes promptly will increase their costs

Failing to pay for changes in timely manner can result in violating prompt payment regulations

Questions?

Yes

Prepare WCD

or FD

Reach

Agreement

Send WCD/FD

to Contractor

Prepare

Engineer’s

Estimate of Time

and Cost Impact

Withdraw

WCD / FD

Contractor Prepares

Cost & Time Estimate

Negotiate cost and

schedule Impacts

with Contractor

Owner Review

Contractor's

Submittal

Contractor

Determine if cost/

schedule

impact

Contractor Notify

the Owner that

cost or schedule

will be impacted

Yes

Contractor perform

the work

Execute

Change Order

Issue Unilateral

Change

CR Accepted

Yes

CR Accepted

Reach

Agreement

Contractor Identifies

a Change

Prepare

Engineer’s

Estimate of Time

and Cost Impact

Withdraw

WCD / FD

Contractor Prepares

Cost & Time Estimate

Negotiate Cost and

ScheduleImpacts

with Contractor

Owner Review

Contractor's

Submittal

Owner’s

Review

Execute

Change Order

Issue Unilateral

Change

Contractor Notifies

the Owner with

Change Request

Contractor

Prepares Claim

Contractor

Withdraws

Request

CR Rejected

Options

Change Request

Title: No.:

Request Date:

Project:

Contractor:

Contract No.:

WO Contract No.:

Initiated by:

Owner Engineer Contractor CM Other:

Change Request

The following change is proposed for the project. Please provide us with your proposed cost and schedule

changes for this request as described below (use additional pages if necessary) :

This work shall be constructed in accordance with the terms and conditions of the Contract Documents .

The Contractor shall provide it’s proposal for this work by _____________________________.

Contractors Proposal:

Increase Decrease $

Increase Decrease Days

Recommendation:

Amount $

Comments

Accept Reject

Reject

HDR Engineering, Inc. Date Otak Date

Local Programs:

Accepted Rejected By:

Date:

Utility Provider: (if required)

Accepted

Rejected

By:

Date:

City:

Accepted Rejected By:

Date: