NEW JERSEY DEPARTMENT OF TRANSPORTATION

AUTHORIZATION FOR UTILITY FIELD CHANGES
PROJECT:	SECTION:
LOCATION:	FEDERAL PROJECT NO:
UTILITY
UTILITY AGREEMENT NO:	TASK ORDER NO:
OR MASTER AGREEMENT NO:	CHANGE ORDER NO:
DESCRIPTION OF CHANGE IN UTILITY WORK (I.E., WORK NOT COVERED BY EXISTING UTILITY AGREEMENT

NECESSARY TO PROGRESS THE STATE’S CONSTRUCTION PROJECT AND THE REASON FOR THE CHANGE (Provide all design elements that need to be changed. Attach necessary documents such as sketches and or drawings and detailed cost breakdown showing -Total labor hours by labor category (laborer vs supervisor) - Labor rates for each category – Material quantities for all materials – Unit costs for each material – Calculations of overhead and profit markups (segregated by subcontractor and prime markups) – and Calculations for markups for other items such as bonds and insurance):
UTILITY ESTIMATE TO NEAREST $1,000:	INCREASE

DECREASE
THE CHANGE IN UTILITY WORK AND COST ESTIMATE HAVE BEEN DISCUSSED WITH AND APPROVED BY:
UTILITY REPRESENTATIVE (Signature)
(Print)
(Date)
RESIDENT ENGINEER (Signature)
(Print)
(Date)
FHWA AREA ENGINEER (Signature)
(Print)
(Date)
(Major Changes on Full Oversight Projects Only)
N.J.D.O.T. PROJECT MANAGER (Signature)
(Print)
(Date)

C:	Utility Coordination Unit (PMO Office)

Regional Construction Engineer

FHWA on Full Oversight Project

Project Manager (Distribute Copies)

Form DC-150U 02/11

UTILITY CHANGES AUTH.

DC-150U

Sanders, Paul

2022-09-06

Sanders, Paul [DOT]

CONSTRUCTION SERVICES

Horizons Computer Services