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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