Sample_Change_Order.pdf

This document is a Sample Change Order template from the Pinellas County Purchasing Department in Clearwater, Florida. The form provides a standardized format for documenting modifications to an existing contract, with designated spaces for fiscal number, change order number, account number, and financial adjustments including total agreement amount, additions, deletions, and new total agreement value. The template includes provisions that require the contractor to waive claims for additional time or compensation related to items included in the Change Order, and acknowledges that the authorized payment represents full compensation for labor, materials, expenses, overhead, profit, and associated work.

The change order form is designed to be executed by multiple parties, including an investigator, Director of Purchasing, County Attorney, Board of County Commissioners representatives, and the contractor. Signature lines are provided for the County Chairman, Clerk, and contractor, with a note specifying "Use Authorized Signatures Only." The form includes a legal acknowledgment that by executing the Change Order, the contractor waives future claims related to the specified work and agrees that the payment represents complete compensation for all associated activities and expenses.