Sample_Change_Order.pdf

This is a sample change order form used by the Pinellas County Purchasing Department in Clearwater, Florida for contract modifications. The form provides a standardized template for documenting additions to or deletions from existing contracts, with designated fields for the fiscal number, change order number, account number, original contract amount, addition amounts, deletion amounts, and the resulting new total agreement value. The change order requires execution by the contractor and must be approved by the County's Investigator, Director of Purchasing, and Office of County Attorney before final authorization by the Board of County Commissioners. The document specifies that contractor execution of the change order constitutes a waiver of all claims for additional time or compensation for activities prior to the change order's execution date and that payment authorized represents full and complete compensation for all labor, materials, incidental expenses, overhead, profit, impact costs, and time associated with the work covered under the modification.

The sample change order form establishes that all claim procedures referenced in the original contract documents remain applicable and that authorized signatures from both County officials and the contractor's designated representative are required for validity. The form includes signature lines for the County's Investigator, Director of Purchasing, County Attorney, Board Chairman, Clerk, and Deputy Clerk, as well as space for contractor company authorization, title, and witness attestation. This template would be applicable to the HVAC renovation project for the Pinellas County Solid Waste Administration Building, allowing for any necessary scope modifications or cost adjustments that may arise during the 365-day project execution period.