Change_Order_Form.pdf
PDF 138 KB Posted
- Attached to
- Rob Sullivan Park Maintenance Barn State and local contract opportunity
- Solicitation number
- 05-15
- Issued by
- Volusia County, Florida
About this file
This is a Change Order Form template for the City of Debary's Rob Sullivan Park Maintenance Barn project (Bid #05-15), establishing the formal structure for documenting contract modifications between the owner and contractor. The form provides designated sections to record the original contract price and time, current adjusted amounts, and proposed changes, with itemized spaces to document up to five distinct changes with their descriptions, reasons, and associated cost and time impacts. Each change order item requires specification of contract price adjustments and contract time modifications measured in days, culminating in a summary table that aggregates all proposed changes to establish the new total contract price and completion timeline.
The document establishes binding financial and temporal terms through a comprehensive waiver clause requiring mutual accord between owner and contractor, with the contractor waiving all rights to file additional contract claims beyond the documented change order. Execution of the change order constitutes full acceptance by the contractor that it is entitled to no further compensation or time extensions, whether direct, indirect, or impact-related. The form requires formal approval signatures from both contractor and owner representatives, with acknowledgment that the change order modifications are subject to all provisions of the original agreement and do not otherwise affect the underlying contract terms except as expressly stated in the change order itself.
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Text version
City of Debary – Rob Sullivan Park Maintenance Barn (Bid # 05-15)
SECTION 00950
CHANGE ORDER FORM
Change Order No.
Project Title
Bid No.
Owner:
Contractor:
Agreement Date:
THE FOLLOWING CHANGES ARE MADE TO THE CONTRACT DOCUMENTS:
(1) Original Contract Price $
(2) Current Contract Price (Adjusted by Previous Change Orders) $
(3) Total Proposed Change in Contract Price $
(4) New Contract Price (Item 2 + Item 3) $
(5) Original Contract Time Days
(6) Current Contract Time (Adjusted by Previous Change Orders) Days
(7) Total Proposed Change in Contract Time Days
(8) New Contract Time (Item 6 + Item 7) Days
(9) Original Contract Substantial Completion Date
(10) New Contract Substantial Completion Date
This Change Order is necessary to cover changes in the work to be performed under this Agreement. The GENERAL CONDITIONS, SUPPLEMENTARY CONDITIONS, and STANDARD SPECIFICATIONS apply to and govern all work under this Change Order.
CHANGES ORDERED
ITEM 1
Description of Change:
Reason for Change:
Change in Contract Price:
Change in Contract Time:
ITEM 2
Reason for Change:
ITEM 3
Reason for Change:
ITEM 4
Reason for Change:
ITEM 5
Reason for Change:
CHANGE ORDER SUMMARY
No. Description Change in Contract Price
Change in Contract Time
TOTAL $ Days
WAIVER This Change Order constitutes full and mutual accord and satisfaction for the adjustment of the Contract Price and Contract Time as a result of increases or decreases in cost and time of performance caused directly and indirectly from the change. Acceptance of this Waiver constitutes an agreement between OWNER and CONTRACTOR that the Change Order represents an equitable adjustment to the Agreement and that CONTRACTOR shall waive all rights to file a Contract Claim or claim of any nature on this Change Order. Execution of this Change Order shall constitute CONTRACTOR’s complete acceptance and satisfaction that it is entitled to no more costs or time (direct, indirect, impact, etc.) pursuant to this Change Order.
APPROVAL AND CHANGE ORDER AUTHORIZATION
ACKNOWLEDGMENTS
The aforementioned change, and work affected thereby, is subject to all provisions of the original Agreement and specifically changed by this Change Order; and
It is expressly understood and agreed that the approval of the Change Order shall have no effect on the original Agreement other than matters expressly provided herein.
ATTEST:
Contractor
(Secretary) Printed Name and Title of Officer
Date By (Signature)
(Corporate Seal) Date
ATTEST:
Owner
(Signature) Printed Name and Title
Date By (Signature)
(Seal) Date
END OF SECTION
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