1. 0 Change Requests



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Design Change Request

Forward to Change Control Board Administrator

Project Manager

     

Telephone

     

Designer

     

Submittal Date

     

Program Manager

     

Concur

Date

     

Route and Section

     


Description of Change

     


Reason for and Value of Change, Advantages and Disadvantages

     


Recommendation:

     


Has the change been reviewed by other offices or CPC Screening Committee? (If yes, list office and contact person)

     


FHWA/State Involvement

PoDI

Non-PoDI

100 % State

Other:      

Cost Breakdown

Original Design Cost

     


Total Previous Revisions

     


Current Revision

     


Total Design Cost

     


Construction Cost

ROW Cost

Total Non-Design Cost

Original

Incr./Decr.

Original

Incr./Decr.

Increase/Decrease

     

     

     

     

     

Director of Project Management

Concur (CCB meeting is necessary)































Signature:







Date:

























Director, Division of Project Management

























- OR - Recommend for approval without CCB meeting based on the following justification and with the following conditions:




     



























































































Signature:







Date:

























Director, Division of Project Management



























CCB Decision for Route






































































Decision of the Change Control Board - Date:





















Concurrence:







Date:

























Eli D, Lambert III, P.E.













Assistant Commissioner













Capital Program Management
























Disapproved:







Date:

























Eli D, Lambert III, P.E.













Assistant Commissioner













Capital Program Management
















New Jersey Department of Transportation

Capital Project Support

Form CON-RQST-2




Construction Change Request

Forward to Change Control Board Administrator

Project Manager

     

Telephone

     

Resident Engineer

     

Submittal Date

     

Change Order or Sequential Letter

     

Contractor

     

Priority

Urgent - 24 hours

Standard 7-10 days

Other – specify:      

Program Manager

     

Concur

Date

     

Route and Section:

     


Description of Change:

     


Current Process or Method:

     


Reason for and Value of Change, Advantages and Disadvantages:

     


Effects:

     


Implementation:

     


Recommendation:

     


Has the change been reviewed by other offices or CPC Screening Committee? (If yes, list office and contact person):

     


FHWA/State Involvement

PoDI

Non-PoDI

100 % State

Other:      

Cost Breakdown

Original Contingency Amount:

Contingency Amount Used:

Construction Cost Incr./Decr.

     


Design Cost Incr./Decr.

     


Row Cost Incr./Decr.

     


Actual Award Amount

     


Total Previous Revisions

     


Current Revision

     


Total Cost

     

Director of Project Management

Concur (CCB meeting is necessary)
































Signature:







Date:

























Director, Division of Project Management

























- OR - Recommend for approval without CCB meeting based on the following justification and with the following conditions:




     





















































































Signature:







Date:

























Director, Division of Project Management



























CCB Decision for Route



































































Decision of the Change Control Board - Date:


















Concurrence:







Date:

























Eli D. Lambert III, P.E.













Assistant Commissioner













Capital Program Management





















Disapproved:







Date:

























Eli D. Lambert III, P.E.













Assistant Commissioner













Capital Program Management













Directory: transportation -> eng
eng -> Notice of requirement for affirmative action to ensure equal opportunity
eng -> State of new jersey equal employment opportunity for contracts funded by wholly state funds
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transportation -> U. S. Department of Transportation (dot) ada regulations
eng -> Equal Employment Opportunity Special Provisions Construction Contracts Funded By Wholly State Funds
eng -> New jersey department of transportation step IV non-binding mediation agreement this agreement
eng -> Standard Federal Equal Employment Opportunity Construction Contract Specifications


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