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Change Order Form <br />No. <br />EFFECTIVE DATE: <br />OWNER: Indian River Countv <br />CONTRACTOR SCS Field Services <br />Project: Landfill Gas Flare Station <br />The following changes are made to 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 <br />$ <br />Change 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 />CHANGE IN CONTRACT TIMES <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 <br />Change Order: <br />(days or dates) <br />Substantial Completion: <br />Final Completion: <br />Net increase (decrease) this <br />Change 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 <br />Date: <br />APPROVED: <br />By: <br />OWNER (Signature) <br />Date: <br />Change Order Form <br />