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DATE OF ISSUANCE: SECTION 00942 - Change Order Form No. EFFECTIVE DATE: OWNER: Indian River County CONTRACTOR Project: Old Dixie Highway Resurfacing (From the I.R.F.W.C.D. North Relief Canal to 71St Street OWNER's Project No. 1137 ENGINEER's Bid No. 2014044 You are directed to make the following changes in the Contract Documents: Description: Reason for Change Order: Attachments: (List documents supporting change) CHANGE IN CONTRACT PRICE: Description Amount Original Contract Price $ 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: ACCEPTED: By: CONTRACTOR (Signature) Date: CHANGE IN CONTRACT TIMES Description 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: By: ENGINEER (Signature) Date: APPROVED: By: OWNER (Signature) Date: 00942 - Change Order Form REV 04-07.doc 00942-1 FAPublic Works\ENGINEERING DIVISION PROJECTS\1137-Old Dixie Hwy Resurfacing IRF North Relief Canal to 71st StWdmim\bid documents\Contract Documents\00942 - Change Order Form REV 04-07.doc Rev. 05/01