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 is designed to document additions or deletions to existing agreements and includes fields for fiscal number, change order number, account number, original agreement total, addition amounts, deletion amounts, and the new total agreement value. The document requires execution by the contractor and approval from the Director of Purchasing, the Office of County Attorney, and the Board of County Commissioners before implementation. By executing the change order, the contractor waives all claims for additional time or compensation related to activities prior to the execution date that are covered under the change order scope.

The sample change order specifies that payment authorized through 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 requires signatures from authorized company representatives, a witness, the County Attorney, the Board Chairman, and the County Clerk or Deputy Clerk. This change order format is applicable to Pinellas County's various procurement activities, including infrastructure projects such as the Fiscal Year 2027 Pavement Preservation Package 3, which involves milling and resurfacing work across approximately 38.92 lane miles of roadway throughout the county.