Sample_Change_Order.pdf
PDF 73 KB Posted
- Attached to
- Palm Harbor Recreation Center Addition State and local contract opportunity
- Solicitation number
- 26-0011-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is a Sample Change Order template from the Pinellas County Purchasing Department in Clearwater, Florida. This standardized form is designed to formally document and authorize modifications to an existing contract, with spaces to record fiscal details, financial adjustments, and necessary approvals from county officials and the contractor.
The change order includes provisions that require the contractor to acknowledge and waive any additional claims or compensation requests related to the changes outlined in the order. The document provides a structured format for recording the total agreement amount, additions or deletions to the contract, and the resulting new total agreement value. Signature lines are provided for key county personnel including the County Attorney, Board of County Commissioners Chairman, Clerk, and the contractor, ensuring proper authorization 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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