CONTRACT CHANGE ORDER NO. Project Name: Contract Date: Contract No.: Project Number: Date of Issuance: Contractor: Contractor is hereby authorized to make the following changes to the Work under the referenced contract: (1) (2) (3) (4) Item Description of Changes-Quantities, Units, Price Price No. Unit Prices, Change in Completion Schedule, Etc. Decrease Increase Change in contract price due to Change Order Total Decrease $0.00 Total Increase $0.00 Difference Between Column (3) and (4) Net Change to Contract Price Contract Time extension: The sum of calendar days; revised completion date: hereby DOES NOT CHANGE the current contract price of making the total adjusted contract price Office of the General Counsel Change Order Form - FM OGC-S-2011-16 (Revised 08.31.2015) . Page 1 of 2 It is mutually agreed that the dollar amount and time extension (if any) set forth in this Change Order constitutes full compensation for all costs, expenses and damages to the Contractor, whether direct, consequential or otherwise, in anyway incident to, or arising out of or resulting directly or indirectly; from the Work performed or modified by the Contractor under this Change Order No. . ACCEPTED BY: Contractor By: Title: Date RECOMMENDED BY: Architect By: Title: Date Date Facilities Management APPROVED BY: Date Date Date Date Date Office of the General Counsel Change Order Form - FM OGC-S-2011-16; Modified 08.31.2015 Page 2 of 2