Sample_Change_Order.pdf
PDF 73 KB Posted
- Attached to
- Utilities light electrical work
- Solicitation number
- 25-0201-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This document is a Sample Change Order template from the Pinellas County Purchasing Department located in Clearwater, Florida. The form provides a standardized format for documenting modifications to an existing contract, specifically for utilities light electrical work, with spaces to record fiscal number, change order number, account number, and financial adjustments to the total agreement amount. The template includes sections for additions, deletions, and calculating a new total agreement value.
The change order form includes important contractual provisions, notably that the contractor's execution of the change order constitutes a waiver of additional time or compensation claims for activities prior to the change order's execution. The document requires signatures from multiple parties, including an Investigator, Director of Purchasing, County Attorney, Board of County Commissioners Chairman, County Clerk, and the contractor, ensuring comprehensive administrative approval and documentation of any contract modifications.
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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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