Sample_Change_Order.pdf

This is a Sample Change Order form issued by the Pinellas County Purchasing Department in Clearwater, Florida for use in connection with a Solid Waste Administration Building HVAC Renovation project. The change order template is designed to document modifications to an existing contract, including additions, deletions, and adjustments to the total agreement amount. The form requires specification of the fiscal number, change order number, account number, original total agreement amount, addition amount, deletion amount, and the resulting new total agreement amount. By executing the change order, the contractor waives all claims or requests for additional time or compensation for activities prior to execution related to items included in the change order and acknowledges that payment represents full and complete compensation for labor, materials, incidental expenses, overhead, profit, impact costs, and time associated with the work.

The change order requires approval and execution by authorized representatives including the Investigator, Director of Purchasing, Office of County Attorney, Board of County Commissioners Chairman, County Clerk, and the contractor. The form serves as the official documentation for contract modifications within Pinellas County's procurement process and must be executed in accordance with the procedures and claim requirements outlined in the underlying contract documents. All signatures must be from authorized representatives only.