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r DATE OF ISSUANCE: SECTION 00942 - Change Order Form No. EFFECTIVE DATE: OWNER: Indian River County CONTRACTOR Bid Number:2008012 r Project: CR 512, PHASE IV ROADWAY IMPROVEMENTS OWNER's Contract No. ENGINEER's Contract No. NIA ENGINEER IRC W r M M C r r W M 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: Descri tion Amount Original Contract Price $ Net Increase (Decrease) from $ previous Change Orders No. Completion: to Final Contract Price prior to this $ Change Order: Net increase (decrease) of this $ Change Order: Substantial Contract Price with all approved $ Change Orders: Completion: ACCEPTED By: CONTRACTOR (Signature) r 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: By: OWNER (Sig Date: 00942 - Change Order Form REV 04-07.doo 00942-1 F:\Engineering\Cap@al Pro*ds\9611-CR 512 Widening19611 CR 512 PHASE INConvact Documents\00942 -Change Order Fonn REV 04-07 doc