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DATE OF ISSUANCE: SECTION 00942 - Change Order Form No. EFFECTIVE DATE: OWNER: Indian River County CONTRACTOR Project: 6T" AVENUE MILLING & RESURFACING FROM U.S. 11S.R. 5 TO 21sT STREET OWNER's Project No. IRC -1638 OWNER'S Bid No. 2022008 FM No.: 438074-1-54-01 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 F:\Public Works\ENGINEERING DIVISION PROJECTS\1638 6th Avenue US -1 to 21st Street Resurfacing (SCOP)\1-Adm1n\Bids\Bid Documents\Master Contract Documents\00942 - Change Order Form REV 04-07.doc