Sample_Change_Order.pdf

This is a Sample Change Order form from the Pinellas County Purchasing Department in Clearwater, Florida, designed for use in construction and service contracts administered by the county. The form provides a standardized template for documenting modifications to existing agreements, including additions and deletions to project scope and corresponding adjustments to contract value. The document includes designated fields for fiscal numbers, change order numbers, account numbers, and original agreement amounts, with separate line items for additions and deletions to calculate the new total agreement value. The form requires execution by the contractor, acknowledgment by company representatives with authorized signatures, and approval by the County Attorney's Office and Board of County Commissioners, with specific signature blocks for the Director of Purchasing, County Attorney, Board Chairman, and Clerk.

The change order form explicitly stipulates that contractor execution constitutes a waiver of all claims or requests for additional time or compensation for activities prior to the change order's execution date related to included items, and that payment authorized by the change order represents full and complete compensation for all labor, materials, incidental expenses, overhead, profit, impact costs, and time associated with the work. The form directs parties to reference the contract documents for applicable claim procedures and establishes clear authorization requirements through witness signatures and dated acceptance, ensuring proper documentation and approval chain for any modifications to the underlying contract agreement.