REQUEST FOR EQUITABLE ADJUSTMENT,

RESERVING DELAY AND IMPACT COSTS

Date

Mr. Contracting Officer

(Address)

Re: (Subject)

Contract number

Dear Sir:

Attached please find the price breakdown and supporting data for my Request for Equitable Adjustment under this contract, for an increase in the contract amount of $ and a contract time extension of calendar days.

I am submitting this request because of

(Describe the problem, differing conditions, direction to proceed with a change, delays, etc.)

Reservations: This proposal is based solely on the usual cost elements such as labor, material and normal mark-ups, and does not include any amount for additional changes in sequence of work, delays, disruptions, re-scheduling, extended or unabsorbed overhead, overtime, acceleration and/or impact costs. The right is expressly reserved to make claim for any and all of these related items prior to final settlement of this contract.

If you have any questions, I would be glad to meet and discuss this matter with you.

Being a small business, I cannot afford to finance this extra cost. I request that you issue a change order to my subcontract for this change as soon as possible.