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The purpose of the study was to identify and rank the prevalence and severity of risk factors construction cost overrun in Public-Private Partnership projects using a case study of Sondu-Miriu Hydroelectric Power Project in Kisumu County, Kenya. This study adopted a descriptive design and collected quantitative data analysed quantitatively using descriptive statistics. In total, 85 persons were identified to have taken part in the management and implementation of the study from whom a sample size of 71 participants was obtained. Questionnaires were emailed to the participants providing details of the study and requesting their participation. The study ranked the risk factors based on prevalence and severity from most prevalently severe to least prevalently severe as design changes, emerging tasks affecting delivery, construction task breakdown structure, design variations and failure of contractors to complete different tasks. Thus, stakeholders should participate fully in the project from design to avoid design changes leading to cost overrun. During implementation, the contractor and construction manager should device mechanisms to anticipate changes in the political environment as such changes determines government policies and decisions affecting the project funding, design and scope.