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
EXTRA WORK ORDER
TO BE PERFORMED ON A FORCE ACCOUNT BASIS
NOTICE: THIS FORM MUST BE TYPEWRITTEN
PROJECT NAME (SECTION) KEY NO. REGION CONTRACT NO.
HIGHWAY PROJECT MANAGER AGENCY PM F.A. PROJECT NO.
CONTRACTOR NAME AND MAILING ADDRESS PM (CONSULTANT OR LOCAL AGENCY) NAME AND ADDRESS EWO NO.
SUBJOB
THE FOLLOWING FORCE ACCOUNT WORK TO BE PERFORMED AND PAID FOR IN ACCORDANCE WITH THE CONTRACT TERMS:
DESCRIPTION AND LOCATION OF EXTRA WORK:
Attach copy of PM's written prior authorization to Contractor to perform work.
ESTIMATE OF QUANTITIES AND COSTS
REASON WORK DESIGN PM ESTIMATED
PAY ITEM CODE TYPE (E OR I) (E OR I) DESCRIPTION AMOUNT
SPECIFICATIONS AND OTHER PROVISIONS --
Labor cost estimates under $10,000 or having industrial accident insurance rates 25% or less may use the standard calculation §197.30(a) when billing
labor costs (Form 1863A). Labor cost estimates greater than $10,000 or having industrial accident insurance rates greater than 25% shall use
§197.30(b) when billing labor costs (Form 1863B).
The labor estimate for this Force Account: Meets Does Not Meet the criteria for §197.30(b)
The contractor has elected to use: §197.30(a) Standard Calculation §197.30(b) Actual Costs for Force Account labor costs
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.
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.
734-3208 (1-2012)
WORK OR CHANGE ORDER SUPPORTING DATA (Page 1)
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 %
Increase Decrease $0.00 #DIV/0!
ESTIMATED STARTING DATE* OR DATE WORK WAS STARTED* WORK/CHANGE IS MAJOR? TO ACCOMPANY (ORDER TYPE & NUMBER)
Yes No EWO 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:
ADDITIONAL INFORMATION THAT IS NOT INCLUDED ON ORDER (Additional Description; Who requested; Why necessary; Why cost is not a contractor responsibility; Parties other than 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 cost estimates for "Extra Work Orders" and "Force Orders"; Why contractor refuses to sign). List all previously approved overruns.
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
This box should be signed by the
ODOT representative for the project
(Project Manager or Local Agency
Liaison)
Do not include
this page in
any submittals
to the
contractor.
The box to the left is a text box.
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).
Tab can be created by using
Ctrl+Tab. Blank lines can be
create by using Ctrl+Enter.
