Sample_Change_Order.pdf

This is a sample change order form from the Pinellas County Purchasing Department in Clearwater, Florida, designed for use in conjunction with state and local contracts. The form provides a standardized template for documenting modifications to existing agreements, including sections for fiscal number, change order number, account number, and itemized additions or deletions to the contract value. The change order requires execution by both the contractor and county officials, including approval from the Office of County Attorney and authorization by the Board of County Commissioners, with signature lines designated for the contractor's company representative, county staff, and witness documentation.

The change order form establishes that execution by the contractor 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. The form explicitly states that payment authorized through the change order represents full and complete compensation for labor, materials, incidental expenses, overhead, profit, impact costs, and time associated with the specified work. Claim procedures are governed by the underlying contract documents, and the form requires use of authorized signatures only for all parties involved in the modification process.