Sample_Change_Order.pdf

This is a sample change order form developed by the Pinellas County Purchasing Department in Clearwater, Florida, for use in contract administration. The document provides a standardized template for documenting modifications to existing agreements, capturing essential information including the fiscal number, change order number, account number, and the financial impact of proposed changes. The form accommodates both additions and deletions to the original contract value, with fields to record the total agreement amount, addition amounts, deletion amounts, and the resulting new total agreement value.

The change order requires execution by both the contractor and county officials to become effective, with signature lines designated for the contractor's authorized representative, the Investigator, the Director of Purchasing, the Office of County Attorney for legal approval, and the Board of County Commissioners through its Chairman. The form includes language stipulating that contractor execution constitutes a waiver of all claims for additional time or compensation related to activities prior to the change order's execution date, and that authorized payment represents full and complete compensation for all labor, materials, incidental expenses, overhead, profit, impact costs, and associated work. The document references that claim procedures are outlined in the underlying contract documents and requires witness certification by the County Clerk's office.