Exhibit_I_-_Change_Order_Form.pdf
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- Solicitation number
- 2025-25
- Issued by
- Miami-Dade County, Florida
About this file
This is a Change Order Form used by the City of Doral, Florida for modifying existing contracts. The form provides a standardized template for documenting modifications to contract terms, including adjustments to scope of work, contract amount, and contract duration. The document accommodates various change scenarios including contract extensions, error corrections, owner-requested modifications, contractor errors, force majeure events, and owner direct purchases. The form requires specification of the project name, project number, original contract amount, previous authorized change orders, the net change amount, and the resulting new contract amount. Contract time modifications are documented separately, indicating whether the timeline is increased, decreased, or remains unchanged. The form requires signatures from the contractor, the Capital Improvements Division Chief or Parks & Recreation Director, and the City Manager to authorize the change order.
The Change Order Form includes sections for documenting the justification for proposed changes and categorizing the reason for modification through checkbox options. Pricing elements are indicated with line items for dollar amounts, though specific values are marked as "N/A" on this template version. The form identifies various change order categories including AHJ (Authority Having Jurisdiction) requirements, errors and omissions, owner requests, contractor errors, vis major (force majeure), and owner direct purchases. This template serves as the administrative mechanism for the City of Doral to formally document and execute contract modifications related to the Third Floor Renovation project at the Doral Government Center for the new City Council Members Area.
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Text version
Project Name:
Project Number:
, dated:
This change order includes all material, equipment and labor for the following scope of work:
Contract extension request: (Calendar Days) Justification Checked by:
Contract expiration date:
Total additional dollar amount requested:
Total Amount of this Change Order:
The City and Contractor agee to modify the original Contract by the following CHANGE ORDER amount:
Original Contract Amount……………………………………………………………………………………………………………….
Net change by Previous authorized Change Orders…………………………………………………………….………..
Contract Amount prior to this Change Order………………………………………………………………………………….
Contract Amount will be (increased)(decrease)(unchanged) in the amount of…………………………..
Contract Deduction for Owner Direct Purchase…
New Contract Amount including this Change Order………………………………………………………….…………..
Contract Time will be (increased)(decreased)(unchanged) by………………………………….….….…………..
Contractor Signature: Date:
Title: President
Authorized CITY Signature: Date:
Title: Capital Improvements Division Chief/Parks & Recs Director
Authorized CITY Signature: Date:
Title: City Manager
"For all the right reasons!"
SM
CHANGE ORDER FORM
To Contractor:
Contractor Address:
0 Days
The City and Contractor hereby agree to perform the changes to the work as shown on the Field Work Order No. , dated: N/A and/or the additional work as described on Proposal Number and/or Change Request:
PROPOSAL DESCRIPTION:
N/A
ACCEPTANCE: The above prices and specifications of the Change Order Proposal are satisfactory and are hereby accepted.
N/A
AHJ Requirement
Errors & Omissions
Owner Request
Contractor Error
Vis Major
Unforseen
Owner Direct Purchase
File details come from the government source that posted it. Updated .