Exhibit_L_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 template used by the City of Doral, Florida for modifying existing contracts related to the third floor renovation project at the Doral Government Center for the creation of a new City Council members area. The form establishes the framework for documenting modifications to the original contract, including changes to scope of work, contract duration, and compensation. The document accommodates contract extension requests measured in calendar days with corresponding justification requirements. Change orders may result from various conditions including Authority Having Jurisdiction (AHJ) requirements, errors and omissions, owner requests, contractor errors, vis major events, unforeseen circumstances, or owner direct purchases.
The Change Order Form requires documentation of the original contract amount, all previous authorized change order amounts, the cumulative contract amount prior to the current change order, and the new total contract amount including the proposed modification. The form allows for increases, decreases, or no change to both the contract dollar amount and contract time period. Execution requires signatures from the contractor and two authorized City representatives: the Capital Improvements Division Chief or Parks & Recreation Director, and the City Manager. The document includes fields for specifying the Field Work Order number, proposal number, change request details, and proposal descriptions, with designated line items for financial calculations related to contract modifications.
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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 .