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DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD
AC&I FINAL DATA FORM CIVIL ENGINEERING PROJECT
Date: Prepared By (Name & Place):
Project Title: Fiscal Year of Project:
Unit Name: OPFAC Number:
SFRL Number: PPR Number:
PP Number: AC&I Project Number:
Brief Project Description:
Estimated IFB Stage Construction Time (Days): Contract Award Amount ($):
Construction Start Date: Number of Change Orders:
Construction Complete Date: Net Cost of Change Orders ($):
Actual Construction Time (Days): Final Project Cost ($):
CATEGORY CODE GROSS SQUARE FEET NET SQUARE FEET
Other Comments (i.e. Excessive Construction Time, Contractor Defaulted, Contractor Claims, etc.):
CG-5517 (02/20) Page 1 of 2
CG-5517 (02/20) Page 2 of 2
Date: Prepared By (Name & Place):
Project Title: Fiscal Year of Project:
Unit Name: OPFAC Number:
SFRL Number: PPR Number:
PP Number: AC&I Project Number:
List the Cost and Scope of All Major Contract Change Orders
Indicate if the reason for the change order is attributed to:A - Design Omission;B - Value Engineering Incentive;C - CQC; orD - Change in Operational of Functional Requirements.
Indicate in which cost item the change order should be accounted:1 - Demolition;2 - Sitework;3 - Exterior Utilities;4 - Waterfront/Marine Construction;5 - Building Construction
6 - Outfitting/Furnishings/Equipment;7 - Electronics; or8 - Other.
Attach additional sheets if necessary.
INSTRUCTIONS• •
•
CHANGE ORDER NUMBER REASON SCOPECOST
ITEM COST