Sample_Change_Order.pdf
PDF 73 KB Posted
- Attached to
- HVAC PM, Repairs and Replacement
- Solicitation number
- 24-0365-ITB-C
- Issued by
- Pinellas County, Florida
About this file
The document is a Sample Change Order template from the Pinellas County Purchasing Department in Clearwater, Florida. This standardized form is designed to document modifications to an existing contract, specifically for an HVAC preventative maintenance, repair, and replacement services contract. The change order template provides a structured format for recording adjustments to the total agreement amount, including additions or deletions, and requires signatures from the contractor, county attorney, and county commissioners.
The change order includes a critical clause stating that the contractor's execution of the document constitutes a waiver of all claims for additional time or compensation related to the activities prior to the change order's execution. The template ensures that the payment authorized represents full compensation for labor, materials, incidental expenses, overhead, profit, impact costs, and associated work. The form is intended to provide a clear, legally-binding mechanism for documenting and approving contract modifications within Pinellas County's procurement process.
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Text version
APPENDIX 2 – SAMPLE CHANGE ORDER
APPENDIX 2 – SAMPLE CHANGE ORDER
SAMPLE CHANGE ORDER
PINELLAS COUNTY PURCHASING DEPARTMENT
CLEARWATER, FLORIDA
FISCAL NO. CHANGE ORDER NO.
ACCOUNT NO.
TO Total Agreement $
FOR Addition $
IN CONNECTION WITH New Total $
Deletion $
New Total Agreement $
Execution by the contractor of this Change Order shall be considered a waiver of all claims or request for additional time or compensation for any activities prior to time of execution related to items included in the Change Order. The contractor also acknowledges that payment authorized by this Change Order represents full and complete compensation for labor, materials, incidental expenses, overhead profit, impact cost, and time associated with this Work. Claim procedures are outlined in the Contract documents.
Investigator
Director of Purchasing APPROVED AS TO FORM: Accepted this day of
OFFICE OF COUNTY ATTORNEY 20
By PINELLAS COUNTY Attorney BOARD OF COUNTY COMMISSIONERS
By Chairman
Attest: KEN BURKE, CLERK By
Deputy Clerk
Use Authorized Signatures Only Company
By Title
Witness
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