5-Consent of Surety-Change Order.pdf.pdf
PDF 648 KB Posted
- Attached to
- Countywide Fire Hydrant Replacement - WORCS-5
- Solicitation number
- IFB-26-00348
- Issued by
- Hillsborough County, Florida
About this file
This is a Consent of Surety to Change Order form used by Hillsborough County, Florida for modification of contractor performance and payment bonds. The document serves as the surety's formal acknowledgment and agreement to adjust bond coverage when a change order is issued to an existing contract. The form requires identification of the contract title, contractor (principal), surety company, and surety agent, along with specific details regarding the change order number, adjusted contract amount, and any extensions to the completion date. The surety must acknowledge that both performance and payment bonds are being modified to reflect changes in contract value and project timeline. The document requires execution by an authorized representative of the surety with an official seal, or alternatively by an attorney-in-fact with supporting power of attorney documentation.
The form requires notarization before a Florida notary public in Hillsborough County, with the notary certifying the date of execution and the identity of the signatory through either personal knowledge or presentation of identification. The notarized signature and printed name of the notary public must be affixed to complete the document. This form is applicable to the Countywide Fire Hydrant Replacement (WORCS-5) project, which involves replacement of fire hydrants, hydrant assemblies, and valves on water mains throughout Hillsborough County under an estimated $1,900,000 contract awarded by the Hillsborough County Water Resources Department. The form was last revised on March 9, 2020.
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Text version
CONSENT OF SURETY TO CHANGE ORDER
CONTRACT TITLE:
CONTRACTOR (PRINCIPAL):
SURETY:
AGENT:
The SURETY does hereby acknowledge and agree to Change Order No. to the above referenced contract with Hillsborough County, the contract amount
(increasing/decreasing) by $ , and/or extending the completion date by ( ) calendar days. The SURETY further acknowledges that the performance bond and/or payment bond furnished under the aforementioned contract is accordingly changed to reflect the change in contract amount, and/or time included in Change Order No. .
This Consent is dated this day of , 20 .
SURETY:
BY: (SEAL)
Authorized Signature
-OR-
BY: (SEAL)
As Attorney in Fact (Attach Power of Attorney)
Printed Name
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
The foregoing instrument was acknowledged before me by means of physical presence or online notarization this ___ day of ____________, 20___, __________________________ by (Name of person)
________________________ for _________________________________________________.
(ie. Officer, attorney in fact) (Name of party on behalf of whom instrument was executed.)
(Signature of Notary Public)
(Print, Type, or Stamp Name of Notary Public)
Personally Know OR Produced Identification
Type of Identification Produced __________________
Revised 03.09.2020
File details come from the government source that posted it. Updated .