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DATE OF ISSUANCE: <br />OWNER: <br />CONTRACTOR <br />Project: <br />OWNER's Project No <br />FM No.: <br />SECTION 00942 — Change Order Form <br />EFFECTIVE DATE: <br />Indian River Cou <br />69TH STREET FROM 66TH AVENUE TO SRS/US-1, RESURFACING <br />IRC -1639 OWNER'S Bid No. 2022028 <br />438073-1-54-01 <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: <br />Description <br />Amount <br />Original Contract Price <br />$ <br />Net Increase (Decrease) from <br />$ <br />previous Change Orders No. <br />to <br />Contract Price prior to this Change <br />$ <br />Order: <br />Net increase (decrease) of this <br />$ <br />Change Order: <br />Contract Price with all approved <br />$ <br />Change Orders: <br />ACCEPTED: <br />By: <br />CONTRACTOR (Signature) <br />Date: <br />IRC -1639 <br />No. <br />CHANGE IN CONTRACTTIMES <br />Description <br />Time <br />Original Contract Time: <br />(days or dates) <br />Substantial Completion: <br />Final Completion: <br />Net change from previous Change <br />Orders No. to <br />(days) <br />Substantial Completion: <br />Final Completion: <br />Contract Time prior to this Change <br />Order: <br />(days or dates) <br />Substantial Completion: <br />Final Completion: <br />Net increase (decrease) this Change <br />Order: <br />(days or dates) <br />Substantial Completion: <br />Final Completion: <br />Contract Time with all approved <br />Change Orders: <br />(days or dates) <br />Substantial Completion: <br />Final Completion: <br />RECOMMENDED: <br />By: <br />ENGINEER (Signature) <br />Date: <br />APPROVED: <br />By: <br />OWNER (Signature) <br />Date: <br />Change Order Form — 00942 <br />F:\Pub1icWorks\ENGINEERING DIVISION PROJECTS\1639 69th Street 66th Avenue to US -1 Resurfacing (SCOP)\1-Admin\Bids\Bid Documents - Advertisement\DIV <br />0 4 Conditions of the Contract - 20211207.docx <br />