HomeMy WebLinkAboutChange Order 1 Annexation Are C-2 Surrey CONTRACT CHANGE FORM
TO: CONTRACT CHANCE ORDER NO.:
DATE: SEPIWIA% `\ , 20 1\
PROJECT NAME: ►1 N1 SRC` t 2" 5%, g E 'f R
ORIGINAL. CITY P.O. NO.:
I. You are directed to make the following changes to this Contract:
ITEM AMOUNT SCI IEDIII.ED ADIUS'1'MENT
016 Surface Asphalt 100.2 Tons ( +) or ( -) DAYS
11. The following referenced documents further describe the changes outlined in Paragraph I, and are
to be considered part of this Change Order:
R.F.1'.: W.U.C.:
III. The changes result in the following adjustment of Contract Price and Contract Time:
Contract Sum Prior to this Change Order $ 3%1 2.00.00
Contract Sum will be increase /decrease by this Change Order S 1 t C) 2.0 . 00
New Contract Sum including this Change Order $ S9 2 2.20 .00
Contract Time Prior to this Change Order Substantial Completion Date
._._ Final Completion Date
Net Increase /decrease resulting from this Change Order Days
Current Contract' lime including this Change Order Substantial Completion Date
Final Completion Date
This Change Order is for hill and final Settlement of all direct, indirect, impact costs and time extension
incurred at any time resulting from the performance of the changed work.
The Above Changes Are The Above Changes are Approved:
Recommended: Accepted: �7 1
___ OF J EFFEesomet e . L ,2.JL / F..J,J f City of leffer onville
Engineer Contractor Owner
Sae Q,.Nonsets &stee Ct. 1/02 ,mod,( 2.L al 500 OuarLermaster Court
Address Address Address
J><rt"caos..ta I 'l ?130 F--SL Kr 4 k) /R Jeffersonville.lndiana 47130
City/State/Zip Cit /State/Zip City tate/Zip
DEacc 'at..Aig. J % / J
By: � E By ;Jet,- B : � / ,
Phone: Sme 35510 Phone 52n) /- 9o0) Phone: 00...07 %
Date: 9 -1Z -11 Date: 3 -l.2- 1) Date: ,c7 //
Jeffersonville, Indiana Additional Forms Supplemental to Agreement Form