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DATE OF ISSUANCE: SECTION 00942 = Change Order Form No. EFFECTIVE DATE: OWNER: Indian River County CONTRACTOR Project: Indian River Blvd. & 17th St, Intersection Improvements Project No. 1024 Bid No. 2011048 ENGINEER Indian River County You are directed to make the following changes in the Contract Documents: Description: Reason for Change Order: Attachments: (List documents supporting change) ACCEPTED By: CONTRACTOR (Signature) Date: �j CHANGE IN CONTRACT TIMES CHANGE IN CONTRACT PRICE: Description Amount Original Contract Time: Original Contract Price $ Substantial Completion: Net Increase (Decrease) from previous Change Orders No. to $ Contract Price prior to this Change Order: $ Net increase (decrease) of this Change Order: $ Contract Price with all approved Change Orders: $ Final Completion: ACCEPTED By: CONTRACTOR (Signature) Date: �j CHANGE IN CONTRACT TIMES Descri tion Time Original Contract Time: (days or dates) Substantial Completion: Final Completion: Net change from previous Change Orders No. to (days) Substantial Completion: Final Completion: Contract Time prior to this Change Order: (days or dates) Substantial Completion: Final Completion: Net increase (decrease) this Change Order: (days or dates) Substantial Completion: Final Completion: Contract Time with all approved Change Orders: (days or dates) Substantial Completion: Final Completion: RECOMMENDED: APPROVED: By: ENGINEER (Signature) Date: By: OWNER (Signature) Date: 00942 -Change Order Form REV 04-07.doc 00942 - 1 F:\Public Works\ENGINEERING DIVISION PROJECTSN024-17thSlreet and IR Blvd Intersection\Admim\Contrad Documents\00942 -Change Order Form REV 04-OLdoc Rev. OS/01