Tentative Daily Extra Work Agreement Template

Project Name: [Project Name]
Project Number: [Project Number, if applicable]
Agreement Date: [Date]
Daily Record Number: [Record Number, if applicable]

Owner / Agency: [Owner or Agency Name]
Contractor: [Contractor Name]
Project Location: [Location]

1. Purpose of Daily Extra Work Record

This Tentative Daily Extra Work Agreement is used to record extra work performed outside the original contract scope or outside previously approved work items.

This daily record is tentative in nature and is intended to document the work performed, the resources used, and the basis for later review, pricing, or change order adjustment.

2. Description of Extra Work

Date of Extra Work: [Date]
Work Location: [Specific Area or Site Location]

Description of extra work performed:

[Describe the extra work]

Reason extra work was required:

[Insert reason]

Requested or Authorized By: [Name and Title]

3. Labor Used

Employee 1 Name: [Full Name]
Classification: [Laborer / Operator / Technician / Other]
Hours Worked: [Number]
Rate: [$Amount, if applicable]

Employee 2 Name: [Full Name]
Classification: [Laborer / Operator / Technician / Other]
Hours Worked: [Number]
Rate: [$Amount, if applicable]

Employee 3 Name: [Full Name]
Classification: [Laborer / Operator / Technician / Other]
Hours Worked: [Number]
Rate: [$Amount, if applicable]

Total Labor Hours: [Number]
Tentative Labor Cost: [$Amount]

4. Equipment Used

Equipment 1: [Description]
Unit Number: [Number]
Hours Used: [Number]
Rate: [$Amount, if applicable]

Equipment 2: [Description]
Unit Number: [Number]
Hours Used: [Number]
Rate: [$Amount, if applicable]

Equipment 3: [Description]
Unit Number: [Number]
Hours Used: [Number]
Rate: [$Amount, if applicable]

Tentative Equipment Cost: [$Amount]

5. Materials Used

Material 1: [Description]
Quantity: [Number]
Unit Cost: [$Amount, if applicable]
Total Cost: [$Amount]

Material 2: [Description]
Quantity: [Number]
Unit Cost: [$Amount, if applicable]
Total Cost: [$Amount]

Material 3: [Description]
Quantity: [Number]
Unit Cost: [$Amount, if applicable]
Total Cost: [$Amount]

Tentative Material Cost: [$Amount]

6. Other Charges

Additional charges, if any:

[Subcontractor costs]
[Delivery charges]
[Disposal fees]
[Special equipment]
[Other]

Tentative Other Charges: [$Amount]

7. Daily Cost Summary

Tentative Labor Cost: [$Amount]
Tentative Equipment Cost: [$Amount]
Tentative Material Cost: [$Amount]
Tentative Other Charges: [$Amount]

Tentative Daily Total: [$Amount]

This total is recorded for daily tracking purposes only and remains subject to later review, verification, and final agreement.

8. Daily Notes

Weather Conditions: [Conditions, if applicable]
Site Conditions: [Conditions, if applicable]

Additional notes regarding delays, access, safety issues, changed conditions, or instructions:

[Insert notes]

9. Tentative Agreement Statement

The parties acknowledge that this daily record reflects the extra work believed to have been performed on the date listed above.

Unless otherwise stated in writing, this document does not by itself create a final change order, final payment approval, or final agreement on price, quantity, or entitlement. Final adjustment, if any, shall be subject to contract terms and later review.

10. Signatures

Contractor Representative Signature: __________________________
Name: [Full Name]
Title: [Job Title]
Date: [Date]

Owner / Agency Representative Signature: __________________________
Name: [Full Name]
Title: [Job Title]
Date: [Date]

Inspector / Field Representative Signature, if applicable: __________________________
Name: [Full Name]
Title: [Job Title]
Date: [Date]