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SECTION 00942 - Change Order Form No. DATE OF ISSUANCE: EFFECTIVE DATE: OWNER: Indian River County CONTRACTOR: Project: OLD DIXIE HIGHWAY AND HIGHLAND DRIVE INTERSECTION IMPROVEMENTS OWNER's Project No. IRC -1362 OWNER'S Bid No. 2019025 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 . $ Substantial Completion: Final Completion: 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: Substantial Completion: Final Completion: (days or dates) Net change from previous Change Orders No. to : (days) Substantial Completion: Final Completion: Contract Time prior to this Change Order: Substantial Completion: Final Completion: (days or dates) Net increase (decrease) this Change Order: Substantial Completion: Final Completion: (days or dates) Contract Time with all approved Change Orders: Substantial Completion: Final Completion: (days or dates) RECOMMENDED: By: ENGINEER (Signature) Date: APPROVED: By: OWNER (Signature) Date: 00942 - Change Order Form REV 04-07 00942 - 1 F:\Public Works\ENGINEERING DIVISION PROJECTS\1362-01d Dixie Hwy_Highland Dr11-Admin\Bid Documents\Master Contract Documents\00942 - Change Order Form REV 04-07.doc Rev. 05/01