Exhibit_L_-_Change_Order_Form.pdf

PDF 155 KB Posted

Attached to
Government Center 3rd Floor Renovation – Recondition of the Existing City Manager’s and Finance Department Office Areas
Solicitation number
2026-16
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 related to government projects. The form provides a standardized template for documenting modifications to original contract agreements, including extensions of contract time and adjustments to contract amounts. The form captures essential project information including the project name, project number, and original contract expiration date. It accommodates various types of changes including contract extensions (measured in calendar days), cost adjustments (increases, decreases, or no change), and deductions for owner direct purchases. The form requires detailed documentation of the scope of work being modified, with space for reference to field work orders, proposal numbers, and change requests. Signatures from both the Contractor (President) and authorized City representatives (Capital Improvements Division Chief/Parks & Recreation Director and City Manager) are required to execute the change order.

The form identifies multiple categories of change order triggers including AHJ requirements, errors and omissions, owner requests, contractor errors, force majeure events, and unforeseen circumstances. All material, equipment, and labor costs for the modified scope of work are to be included within the change order amount. The form requires calculation of the new total contract amount after the change order is applied and documentation of any modifications to the contract timeline. Pricing terms and specific dollar amounts are entered directly on the form during the change order process, with space for both the total additional dollar amount requested and the final total amount of the change order.

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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 .