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CITY OF SEBASTIAN CHANGE ORDER FORM
CHANGE ORDER #: CX1 l PROJECT NAME: p�:ll_�lllil 1i", �I f> .; ti•�
PLMCEIASE ORDER#: PROJECT N:
:32(;171-/;['Lica
CONTRACTOR:/�%m CONTACT NAME:
ADDRESS: A CONTRACT DATE: J"'Zi ZL49
By the signature affixed below, both the City and the Contractor agree to the changes as stipulated herein. Upon
proper execution of this document, the Contractor is hereby notified to commence work. Alf changes stated below
are hereby incorporated and trade a part of the Contract identified above, and all the terms and conditions of said
Contract are enjoined and in full force while executing the changes) stipulated as follows:
DESCRIPTION: ��Ip 11 ifl:.UC'.fT TV (�(,1 Lse 'J,sr`L-r C'e'S
AI CONTRACT PRICE PRIOR TO THIS CHANGE
NET INCREASE (DECREASE) RESULTING FROM THIS CHANGE
NEW CONTRACT PRICE INCLUDING THIS CHANGE ORDER
BI CONTRACTn.mE PRIOR TO THIS CHANGE(NUNISER OF DAYS)
NET INCREASE (DECREASE) RESULTING FROM THIS CHANGE (NUMBER OF DAYS
NEW COMPLETION DATE INCLUDING THE CHANGE
AGREED -
CONTRACTOR, /T
Authorized49mux : �\
Aonrovats Dv Cit, or Sebastiuv Staff-.
CIT/)%�' SSEESOTTIAjN:
Date: -r-I I _ /,/'7 / 'I
/Authdrized'City Manager
5 P7, C .
5
g ZTSTL''.�C
Date: '4
_CBy Manager Authorization -cumulative amount less than 15% or contract price or 515,000 single change order.
y/ City Council Autho tl - cumulative amount es"eds 15%or the contract price or 515,000 single change order.
(?I gDate e/e9 9 I
CITY OF BA5Tj1�'
/fi- �J�S�9
1, Y angerr Dale,
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AchoiniManager rataeneineerivR�
Adminbtrative Service env lvagm
City Attorney a iv I,+.vl ane a Williams, City Clerk - - -
PrReurement Manager u m purohuing - -