Sample_Change_Order.pdf
PDF 73 KB Posted
- Attached to
- FY 2026 Pavement Preservation Package 3 Step 2
- Solicitation number
- 25-0072-ITB-C STEP 2
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is a Sample Change Order template from the Pinellas County Purchasing Department in Clearwater, Florida. The form provides a standardized framework for documenting modifications to an existing contract, including potential additions or deletions to the total agreement amount. It includes spaces for fiscal number, change order number, account number, and financial adjustments.
The change order template includes important legal provisions stating that the contractor's execution of the change order waives claims for additional time or compensation for activities prior to the change order's execution. The document requires signatures from multiple parties, including the Investigator, Director of Purchasing, County Attorney, County Commissioners, Clerk, and the contracting company. The form emphasizes that the authorized payment represents full compensation for labor, materials, expenses, overhead, profit, impact costs, and associated work, with claim procedures outlined in the original contract documents.
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Text version
APPENDIX 2 – SAMPLE CHANGE ORDER
APPENDIX 2 – SAMPLE CHANGE ORDER
SAMPLE CHANGE ORDER
PINELLAS COUNTY PURCHASING DEPARTMENT
CLEARWATER, FLORIDA
FISCAL NO. CHANGE ORDER NO.
ACCOUNT NO.
TO Total Agreement $
FOR Addition $
IN CONNECTION WITH New Total $
Deletion $
New Total Agreement $
Execution by the contractor of this Change Order shall be considered a waiver of all claims or request for additional time or compensation for any activities prior to time of execution related to items included in the Change Order. The contractor also acknowledges that payment authorized by this Change Order represents full and complete compensation for labor, materials, incidental expenses, overhead profit, impact cost, and time associated with this Work. Claim procedures are outlined in the Contract documents.
Investigator
Director of Purchasing APPROVED AS TO FORM: Accepted this day of
OFFICE OF COUNTY ATTORNEY 20
By PINELLAS COUNTY Attorney BOARD OF COUNTY COMMISSIONERS
By Chairman
Attest: KEN BURKE, CLERK By
Deputy Clerk
Use Authorized Signatures Only Company
By Title
Witness
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