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i <br /> I <br /> j SECTION 00942 - Change Order Form <br /> No. j <br /> DATE OF ISSUANCE: EFFECTIVE DATE: <br /> OWNER: Indian River County i <br /> CONTRACTOR <br /> Project: 43R1 AVENUE SIDEWALK IMPROVEMENTS FROM AVIATION BOULEVARD TO <br /> AIRPORT DRIVE WEST <br /> OWNER's Project No. 1123 <br /> OWNER'S Bid No. 2017013 <br /> FM No.: 431725-2-58-01 <br /> You are directed to make the following changes in the Contract Documents: <br /> Description: <br /> Reason for Change Order: <br /> Attachments: (List documents supporting change) <br /> CHANGE IN CONTRACT PRICE: CHANGE IN CONTRACT TIMES <br /> Description Amount Description Time <br /> Original Contract Price $ Original Contract Time: (days or dates) <br /> Substantial Completion: <br /> Final Completion: <br /> Net Increase(Decrease)from $ Net change from previous Change <br /> previous Change Orders No. Orders No to (days) <br /> to Substantial Completion: <br /> Final Completion: <br /> Contract Price prior to this $ Contract Time prior to this Change <br /> Change Order: Order: (days or dates) <br /> Substantial Completion: <br /> Final Completion: <br /> Net increase(decrease)of this $ Net increase (decrease)this <br /> Change Order: Change Order: (days or dates) <br /> Substantial Completion: <br /> Final Com letion: <br /> Contract Price with all approved $ Contract Time with all approved <br /> Change Orders: Change Orders: (days or dates) <br /> Substantial Completion: <br /> Final Completion. <br /> ACCEPTED: RECOMMENDED: APPROVED: <br /> By: By: By: <br /> CONTRACTOR,(Signature) ENGINEER(Signature) OWNER (Signature) <br /> Date: Date: Date: <br /> 00942-Change Order Form REV 04-07 <br /> 00942-1 <br /> F\Public WorksIENGINEERING DIVISION PROJECTW 123 43rd Ave Sidewalk Improvements 26th St.to Airport or West\Admimlbid documents\Master Contract <br /> Documents=942-Change Order Form REV 04-07.doc Rev 05101 <br />