CHANGE ORDER SUMMARY
CONTRACTOR NAME****
Contractor/Subcontractor NameTotal (from cost breakdown)Markup on sub (if applicable)**Total
1.$0.00
2.$0.00
3.$0.00
4.$0.00
5.$0.00
Total (L/M/E/S) $0.00
Business Privilege Tax
(Only Where Applicable)
TOTAL THIS CHANGE$0.00
Notes
* Base Rate and Fringe Rate from Certified Payrolls
** Refer to General Conditions for maximum percentages
*** Penn State is a tax-exempt entity and does not pay sales tax on exempt "Building machinery
and equipment items" under Act 45
**** Each contractor (prime or sub) involved with this change must submit cost breakdown sheet and be
identified as Sub or Prime contractor