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DATE OF ISSUANCE: SECTION 00942 -Change Order Form M EFFECTIVE DATE: OWNER: Indian River County CONTRACTOR Project: 27TH AVENUE AT 21sT STREET SW INTERSECTION/SIGNALIZATION IMPROVEMENTS OWNER's Project No. IRC -1643 OWNER'S Bid No. 2017063 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 00942-1 FAPublic Works\ENGINEERING DIVISION PROJECTS\1643 27th Avenue at 21st Street SW Intersection_Signalization Improvements\7-Admin0d Documents\Master Contract Documents\00942 - Change Order Form REV 04-07.doc Rev. 05101