Sample_Change_Order.pdf

This is a sample change order form from the Pinellas County Purchasing Department in Clearwater, Florida, designed for use with the Chesnut Park Managed Aquifer Recharge (MAR) Well Drilling and Completion of Subsurface Testing project. The change order template accommodates modifications to existing contracts, allowing for additions and deletions to the total agreement value. The document includes designated fields for fiscal number, change order number, account number, and dollar amounts for additions and deletions, with a final section for calculating the new total agreement value. The form requires execution by both the contractor and authorized Pinellas County officials, including approval from the Office of County Attorney and signature by the Board of County Commissioners. The change order explicitly states that contractor execution constitutes a waiver of all claims or requests for additional time or compensation for activities prior to execution related to the included items, and that authorized payment represents full and complete compensation for labor, materials, incidental expenses, overhead, profit, impact costs, and time associated with the work.

The form serves as the official instrument for processing contract modifications within Pinellas County's procurement framework and requires signatures from authorized company representatives and county officials to become effective. All change orders must follow the claim procedures outlined in the original contract documents and must be processed through the Pinellas County Purchasing Department and County Attorney's office. This standardized form ensures compliance with Pinellas County's administrative procedures and provides a clear record of all contractual modifications, protecting both the county and contractor by establishing that payment for change order work constitutes full settlement of related claims and disputes.