Sample_Change_Order.pdf

This is a sample change order form from the Pinellas County Purchasing Department in Clearwater, Florida, designed for use in connection with county construction contracts. The form provides a standardized template for documenting modifications to existing agreements, including additions and deletions to contract scope and associated costs. 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 authorized representative and a witness.

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 that are related to included items. The contractor acknowledges 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, with claim procedures outlined separately in the underlying contract documents. The form includes fields for recording the fiscal number, change order number, account number, original total agreement amount, addition amount, deletion amount, and the resulting new total agreement amount.