Sample_Change_Order.pdf

This document is a Sample Change Order template from the Pinellas County Purchasing Department in Clearwater, Florida. The form is designed to document modifications to an existing contract, with spaces to record fiscal and account numbers, total agreement amounts, additions, deletions, and new total agreement values. The template includes provisions that when a contractor executes the change order, they waive claims for additional time or compensation for activities prior to execution and acknowledge that the payment represents full compensation for labor, materials, incidental expenses, overhead profit, impact costs, and associated work.

The change order requires multiple signatures for approval, including an Investigator, Director of Purchasing, County Attorney, Board of County Commissioners Chairman, Clerk, and the contractor's authorized representative. The document emphasizes that only authorized signatures should be used and that claim procedures are outlined in the original contract documents. While the specific details of the change are left blank in this sample template, the form provides a standardized mechanism for formally documenting and approving contractual amendments within Pinellas County's procurement process.