Sample_Change_Order.pdf

73 KB Posted

Attached to
Chesnut Park Managed Aquifer Recharge Well Drilling And Completion Of Subsurface Testing
Solicitation number
26-0046-ITB-C
Issued by
Pinellas County, Clewiston City, Florida

About this file

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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, with designated spaces for fiscal number, change order number, account number, and financial adjustments including total agreement amount, additions, deletions, and new total agreement values.

The change order includes critical legal language stipulating that the contractor's execution of the document constitutes a waiver of claims for additional time or compensation 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 multi-level administrative approval and validation of the contract modification.

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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

File details come from the government source that posted it. Updated .