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40 <br />+! <br />I <br />:Instructions on reveUe side) No. <br />PROJECT: DATE OF ISSUANCE: <br />OWNER: <br />{Name, <br />Address) ' <br />CONTRACTOR. OWNER's Project No, <br />ENGINEER: <br />CONTRACT FOR: <br />ENGINEER'S. Project No. <br />You are directed to make the following changes in the Contract Documents, <br />Description: <br />Purpose of Change Order: <br />Attachments: (List documents supporting change) <br />CHANGE IN CONTRACT PRICE. <br />CHANGE IN CONTRACT TIME: <br />Jriginal Contract Price <br />Original Contract Time <br />S = <br />d+rs <br />Previous Change Orders No. to No. <br />i <br />Net change from previous Change Orders <br />ter+ <br />Contract Price prior to this Change Order <br />Contract Time Prior to this Change Order <br />a.r. w due <br />'Iet Increase (decrease) of this Change Order <br />P.at Increase (decrease) of this Change Order <br />S <br />} d.rl <br />Contract Price with ail approved Change Orders <br />Contract Time with all approved Change Orders <br />days a due <br />tECOMMENDEO: <br />1 by —^ <br />1,.,ICDC No. 1910.84111987 Fditinnt <br />APPROVED: <br />"PROVED: <br />by c- 1 by ronv+c"ae <br />