In the appropriate boxes, provide:
- Local Education Agency (LEA) name.
- Name of the Facility associated with the project work.
- State Project Number with the letter suffixes indicating project type (Note: projects granted renovation status are identified with suffix RNV).
- State Change Order Number (SCO No.) being submitted. All State Change Orders submitted to DAS must be SEQUENTIAL regardless of phasing. Multiple contractor change orders can be listed on page 2 of 2.
- Contractor Change Order Number (optional) column is provided for your record keeping purposes if maintaining identification numbers which differ from the State numbers.
- Original Construction Contract Sumis the total of the awarded publicly bid trade contracts; typically, the “hard cost” of the construction project associated with the change order.
- Net Cost of All Previous Change Orders is a running total of all previous construction contract revisions. For example, if submitting SCO #01, this line will be $0.00. For SCO #2 this will be the total amount shown as the cost of SCO #01, regardless of eligibility determination. For SCO #3, this will be the total amount of SCO #01 plus SCO #02, etc.
- Cost of This Change Order is the sum of the ELIGIBLE ITEMS + INELIGIBLE ITEMS shown on page 2 of 2 and must match exactly the total on the SCG-043.CO, State Change Order Summary spreadsheet and also equal the costs shown in the backup submitted. FORM SCG-042.CO values which do not match the submitted State Change Order Summary spreadsheet will either be returned to the LEA as unreviewable or will have a pro-rated cost adjustment made for the difference in the change order values and shown on the determination letter.
- Reason for change and/or description of unforeseen circumstance. Briefly describe the change and the reasons, for example, code requirement, unforeseen circumstance, or emergency situation which led to the making of this change order. The second page of the form provides space for a list of itemized overview of the change order reason. Enclose attachments to justify costs for each line entry on the accompanying SCG-043.CO change order spreadsheet.
- On the first page of the form under the section labeled Certifications: Check the appropriate box in the certification section indicating whether the change order is being submitted as fully eligible, fully ineligible, or partly eligible and ineligible. Obtain all signatures and dates on the appropriate lines. Note that the date(s) shown in the certifications section are not relevant to the six-month submission requirement.
- On the second page of the form, provide details of the change order cost categorized by Eligible Items and Ineligible Items, , or indicate “refer to attached spreadsheet”. Use positive costs for items new to the contract and project cost increases. Use negative costs for deletions or decreases to the project. List and sum the cost changes for all eligible items and also for all ineligible items included in this change order in the spaces provided. The total value indicated in the "Cost of this Change Order” line on the front page is the sum of all eligible items and ineligible items.
- In the same state change order, provide adds and deducts for back charges which will result in a zero bottom-line on the spreadsheet.
