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SECTION 00942 - Change Order Form No . DATE OF ISSUANCE : EFFECTIVE DATE : OWNER : Indian River County CONTRACTOR Contract : Project : Paving and Drainage Improvements to 17th Lane SW from 27th Avenue to East approx . 900 ' . 20 Avenue from 21 s' Street SW to 17 Lane SW and 17th Lane from Falcon Trace Project Entrance to 20thAvenue . OWNER's Contract No , ENGINEER's Contract No ' s . 0803 . 0837 . 0838 ENGINEER Indian River County 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 : rchGanggoenfrom CONTRACT TIMES Description Amount Description Time Original Contract Price $ ract Time : (days or dates) ubstantial Completion : Final Completion : Net Increase ( Decrease) from $ previous Change previous Change Orders No . Orders No . to (days) to Substantial Completion : Final Completion : Contract Price prior to this $ Contract Time prior to this Change Change Order: Order: (days or dates) Substantial Completion : Final Completion : Net increase (decrease) of this $ Net increase (decrease) this Change Order: Change Order: (days or dates) Substantial Completion : Final Completion : Contract Price with all approved $ Contract Time with all approved Change Orders : Change Orders : (days or dates) Substantial Completion : Final Completion : ACCEPTED : RECOMMENDED : APPROVED : By : By : By : CONTRACTOR (Signature) ENGINEER (Signature) OWNER ( Signature) Date : Date : Date : 00942 - Change Order Form REV 04-07 00942 - 1 FAEngineering\Capital Projects10803 17th Lane SW Roadway Improvements from 27th Ave to approx. 900 LF east of 27th Ave\0803 Contract Documents100942 - Change Order Form REV 04-07.doc Rev. 05/01